Between a Rock and a Hard Place: Hip Fracture Repair in an Elderly Patient with Severe Cardiac Comorbidities and Limited Options: A Problem-Based Learning Discussion.

Perioperative right ventricular dysfunction can be life-threatening. Anesthetic management of elderly patients with hip fractures and advanced cardiac disease poses considerable perioperative risks. The problem-based learning discussion examines the management of an 87-year-old female with severe pulmonary hypertension, right ventricular dysfunction, and recent anticoagulation scheduled for urgent hip fracture repair. A tailored management approach included peripheral nerve blocks, intraoperative transesophageal echocardiographic monitoring, goal-directed hemodynamic support, and management of acute RV decompensation with intratracheal milrinone and inhaled epoprostenol. It presents strategies for high-risk geriatric trauma patients, individualized anesthetic planning, and the role of pulmonary vasodilators.