Blood loss and left ventricular failure

[Cherrypicker999]

I would appreciate a view on this:

A 76 year old man has elective surgery to remove gall stones using keyhole surgery.
He has no history of heart problems.

Haemoglobin levels are as follows:

9:30am 13.6 (surgery started at 9:30 and ends at 11:30am)
2pm 4.4
3pm 2.2

Estimated blood loss during surgery = 500ml

Can one conclude (1 or 2):

A. The patient suffered modest post-operative blood loss
B. The patient suffered severe post-operative blood loss

Is the answer obvious?

The patient suffers left ventricular failure at 3pm and pronounced dead
at 3:50pm.

Would such a degree of blood loss result in left ventricular failure?


Can one conclude (1 or 2):

1. Given that he had little evidence of significant pre-existing heart disease and given that fluid/blood loss was modest post-operatively, the severity of his heart problems are difficult to account for.”

2. Given that he had little evidence of significant pre-existing heart disease and given that fluid/blood loss was severe post-operatively, the severity of his heart problems can be explained by the severe blood loss.

Is the answer obvious?

Any comments are appreciated.

[admin]

Blood Loss

I can't see how a 500ml loss of blood could have caused this. In my view the answers are: -

A and 1

He had no history of heart problems, but he was 76. How can you be sure he only lost 500ml during surgery? His Haemoglobin levels were dropping a lot! I think it's more likely the surgeon cut something accidently (this often happens in keyhole) and the guy lost more then 500mls, and that is what caused left ventricular failure and death.

[Cherrypicker999]

Correct Answers

If only 500ml blood was lost during the operation (as measured by the anaethetist), then for Hg to drop to 4.4 and 3.2 must can only be due to massive blood loss, post-operatively.
i.e after the operation. Yes, either the doctor cut something, a clip fell off or blood was oozing.

Hence he suffered massive post operative blood loss. Answer = B


Since massive blood loss (even 1/3 blood) can result in left ventricular failure, and there was NO history of heart problems,
the left ventricular failure can be attributed to the substantial post operative blood loss. Answer = 2

[admin]

Blood Loss

When I put my answers I meant that 500ml was a small blood loss, so thats why I put (B) the patient did not suffer much blood loss, as 500ml is not a lot of blood to lose - see what I mean ?

I also put 1 because if we were taking the 500ml as genuine then the answer had to be 1.

I suppose I realised the blood loss was large, but put the answers to the 500ml proposed. I should have put the answers the other way round, as that's what I suspected, as my final summing up shows.

I got there in the end I guess! I did realise that the problem was that the blood loss was much more then 500ml, and suggested a reason why.

Did I do really crap? :?

Have you got any more like this? It's interesting!