Questions will be guided by Army Gas, myself, and the clinical director at Gonzaga University school of anesthesia.

CASE:

A 59-yr-old woman, with a weight of 75 kg and height of 60 inches was scheduled for a laparoscopic cholecystectomy because of acute cholecystitis.

All: PCN, Meds: Albuterol, Lotensin

ROS is remarkable for HTN & smoking. Physical exam reveals middle age female in acute distress 2nd abd pain and nausea – Normal habitus. Lungs expiratory wheezes , Cardiac S1 S2 w/o R/G/+2 pansystolic murmur at 5th ICS MCL. Denies cardiac hx and claims to have adequate exercise tolerance > 4METS. Remainder of systems are unremarkable. Airway MP 3, TMD 2FB. Neg. GERD. Attempted to take Maalox 30 cc x 3 2.5 hours ago.

Labs 16/47, K 3.8, creat 1.5, CXR clear, 12 Lead shows ST at 116.

Previous GA (T&A) and Regional (CLE) without issue. 20 g placed in ED ( in the antecub to piss us off) – patient has received 650 cc LR, 10 mg Reglan, 12.5 Promethazine, and 10 mg MS.

VS 118, 32 – 34, 92%, 92/58, 100.5

Questions: What are you concerns and how would you proceed?

PS Mike let a few student answer - I know your quick on these -