Chapter 7, Problem 26R

Mrs. Ortex has been admitted to your surgical center for a breast biopsy under local anesthesia. This is the second beast biopsy for her, having had the first one 12 months prior to today. She is accompanied by her husband of 14 years. They have three children, ages 2, 8, and 10. Both appear relaxed, joke with you as you admit her, and seem not be overly worried about the results of the upcoming biopsy.  The surgeon has previously informed the patient of the procedure, risks, alternatives, desired outcomes, and possible complications. You give the surgery permit form to the patient for her signature. She readily states that she knows about the procedure and has no additional questions; she signs the form with no hesitation. Her husband now acknowledges that he is worried about the procedure itself and that something could be said during the procedure to alarm his wife.  What do you do at this point? Do you alert the surgeon that informed consent has not been obtained? Do you request…

The patient was a 44 year-old male with a past medical history significant for hypertension, non-insulin-dependent diabetes, high cholesterol, and heavy smoking (2 packs/day). He presented to the emergency room with complaints of chest pain and was found to have suffered a myocardial infarction (heart attack). A cardiac catheterization on hospital day 3 showed three arterial occlusions, and he underwent a triple-bypass on hospital day 5. On day 7, he developed septic shock with acute respiratory and renal failure, requiring intubation. He had a fever at that time of 39.3° C and two blood cultures were obtained. A chest x-ray showed left lung pleural effusion and a chest tube was inserted to drain the effusion. On day 11, pus was leaking from the sternal wound. Cultures derived from the wound and from the chest tube grew the organism noted in figures 1 and 2. A Kirby-Bauer disk diffusion assay is shown in figure 3. Figure 1: Organism under 1000x !! 200 Figure 2: Organism grown on 5% BAP…

The patient was a 44 year-old male with a past medical history significant for hypertension, non-insulin-dependent diabetes, high cholesterol, and heavy smoking (2 packs/day). He presented to the emergency room with complaints of chest pain and was found to have suffered a myocardial infarction (heart attack). A cardiac catheterization on hospital day 3 showed three arterial occlusions, and he underwent a triple-bypass on hospital day 5. On day 7, he developed septic shock with acute respiratory and renal failure, requiring intubation. He had a fever at that time of 39.3° C and two blood cultures were obtained. A chest x-ray showed left lung pleural effusion and a chest tube was inserted to drain the effusion. On day 11, pus was leaking from the sternal wound. Cultures derived from the wound and from the chest tube grew the organism noted in figures 1 and 2. A Kirby-Bauer disk diffusion assay is shown in figure 3. Figure 1: Organism under 1000x ANG 2 ALLEY CO ALE S Co H Feren bete…