Educating Family Physician Residents for Anesthetic Preoperative Evaluation and Assessment.

Introduction: Encounters for preoperative assessments are common within primary care offices, so it is imperative that family medicine residents learn how to perform preoperative evaluations. We assessed family medicine residents' knowledge of preoperative evaluation in preparation for surgery by providing a pre- and post-test alongside a didactic seminar. Methods: A didactic seminar on preoperative evaluations was presented at a family medicine resident didactics session by two senior anesthesiology residents. A 16-question, multiple choice test was used as both a pre-test and post-test to assess family medicine residents' knowledge. Results: A total of 31 participants took the pre-test (residents = 24; medical students = 7), and 30 participants took the post-test (residents = 23; medical students = 7). Mean scores and standard deviations were calculated for both tests with an average score of 37.50% ± 10.58% and 45.42% ± 11.12% on the pre- and post-test, respectively. Using the Kruskal-Wallis test, residents showed a significant improvement in test scores following the didactic presentation (p = 0.041), while overall results (residents and medical students) also reported a significant difference (p = 0.004). Conclusions: Our results demonstrated that educating family medicine residents and medical students on preoperative evaluation showed significant, quantifiable gains in knowledge following a brief didactic presentation. Given the current gap between guidelines and practice, our results emphasize the need for a formal medical school and residency-based curriculum related to preoperative patient evaluation.

Catastrophic pulmonary haemorrhage after endobronchial biopsy of necrotic lung mass.

Flexible bronchoscopy (FB) is instrumental in the diagnosis and treatment of respiratory illness, with low rates of bleeding post-procedure but unpredictable degrees of severity. Although exceedingly rare, massive pulmonary haemorrhage after FB is often catastrophic. We present a case of massive pulmonary haemorrhage after endobronchial biopsy of a 67-year-old patient with a prior diagnosis of right upper lobe (RUL) necrotic lung mass. Imaging revealed possible lymphangitic carcinomatosis and tumour invasion into the lymphatics and vasculature. Significant RUL tumour burden was visualized during the procedure, however, routine endobronchial biopsy resulted in massive pulmonary haemorrhage leading to pulseless electrical activity. Prevention of massive pulmonary haemorrhage may be possible with identification of known risk factors. Catastrophic outcomes from massive pulmonary haemorrhage remain high despite current therapies. Further studies identifying modifiable risk factors, treatment protocols, and the formulation of a multi-disciplinary action plan could prove lifesaving.

Lidocaine Infusion for the Treatment of Headache Associated With Subarachnoid Hemorrhage: A Case Report.

Headache after subarachnoid hemorrhage and corresponding craniotomy with aneurysm clipping can be severe and difficult to treat. Currently accepted analgesic therapies are often ineffective at treating the pain without incurring unacceptable side effects. We present an innovative approach wherein intravenous lidocaine infusions were used to successfully treat 2 patients with hyperalgesia refractory to traditional analgesic therapies. Opioid consumption fell to zero for both patients during lidocaine infusions without lidocaine toxicity. Moreover, after discontinuation of lidocaine infusions, both patients reported good pain control using only standard oral medications.