Distance patent for C3/4 laminectomy.
Background
- Respiratory disease
- Ex-smoker
- 2015: FEV1 1.6, SpO2 91%
- HCV + but no viral load, spontaneously cleared
- 4WW, independent with ADLs
Events
- Distance patient, in-person review not arranged.
- Requested ECG from GP, spirometry on arrival
- Patient in the anaesthetic bay at 5pm, wheezy, SpO2 84%, FEV1 1L, ECG – RBBB, no improvement with bronchodilator.
- Surgery cancelled; patient admitted to the ward for TTE (? Cardiac contribution) and respiratory r/v.
What can be learnt?
- Should they have been reviewed in person?
- Challenging times, differential lockdowns from our district to another. Risk of patients having to self-isolate for 14 days if they attend a clinic appointment.
- Our preferences may not align with the patient’s choice.
- Were there red flags?
- 91% SpO2 on RA documented 5yrs previously.
- Would be useful to ask GP for updated set of observations. This would provide reassurance (if normal) or would prompt a review and optimization (if abnormal).
- Who should have spirometry?
- Evidence suggests it is indicated for:
- The identification and characterisation of respiratory disease (obstructive and restrictive).
- Patients with COPD or asthma, where there is suspected deviation from best baseline.
- Thoracic surgery- assessment of post-operative predictive lung function.
- Evidence suggests it is indicated for: