This is kind of a two-in-one thread - first a case scenario and then a more general clinical practice question for the more experienced folks.


Patient is in their late 50's coming in for simple cystectomy with ileal conduit for neurogenic and adjacent CA (couldn't really get the surgeon to pin down a precise reason for this surgery). Patient has a long list of allergies and a fairly complicated history - most significantly DMII, paraplegia and a recent admission for sepsis d/t a large sacral decubitus. The patient has been a SNF resident for a while before all this went down. Preop labs are mostly normal - Hct is 32, albumin is low. Pt has a couple of "abnormal" EKG's per the reports, but they actually look ok and there is a recent normal dobutamine stress echo. Rumor has it that this surgeon will take all day and then some to finish this case.

Students, what is your initial fluid management strategy for this patient? What kind of access & monitors do you want?