PIG Meeting: 25th February 2021
79yo nursing home resident with an invasive, fungating BCC or SCC on his leg.
- 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
- Low exercise tolerance 3.6METS on DASI
- Profound SOB
- Rpt TTE – relatively unchanged, mild improvement
- Hb 117 -> 83, ? Cause. Nil obvious bleeding.
- Likely contributing to his SOB
- 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.