PIG Meeting: 25th February 2021

79yo nursing home resident with an invasive, fungating BCC or SCC on his leg.

Background

• Cardiac disease
  • PPM for AF/CHB
  • Admitted with CCF last year – found to have PHTN with TR and RV failure.
  • Improved, discharged to NH
• T2DM diet controlled
• RA
• CKD
• Low exercise tolerance 3.6METS on DASI

Issues

• Profound SOB
  • Rpt TTE – relatively unchanged, mild improvement

• Anaemia
  • Hb 117 -> 83, ? Cause. Nil obvious bleeding.
  • Likely contributing to his SOB

Discussion

• Should he have surgery?
  • Overall life expectancy appears short
  • Surgeon, family and patient all keen to proceed
  • Essentially palliative surgery for pain/symptom relief

• Opportunities for optimisation?
  • Cardiologist r/v suggests HF reasonably controlled
  • PRBC transfusion (likely as part of surgical admission due to logistic challenges with patients in NH)

• Anaesthetic technique?
  • Skin grafting required so SAB likely ideal. Care with haemodynamic given pulmonary hypertension.