|A 70-year-old male presents 4 days postoperatively, following elective abdominal aortic aneurysm repair, now in the intensive care unit with respiratory distress.
Ischaemic heart disease
Osteoarthritis, with limited exercise tolerance
Peripheral vascular disease
Glyceryl trinitrate prn
ECG: two ECGs presented; the first showed normal sinus rhythm, the second showed fast atrial fibrillation.
Chest X-ray: diffuse haziness, increased at right base.
Urea: 14 mmol/L
Creatinine: 170 µmol/L
Arterial blood gases:
PaO2 11 kPa
PaCO2 6.5 kPa
1. Why is this patient in respiratory distress?
2. What are the causes of raised hemidiaphragm?
3. What is your interpretation of the arterial blood gas results?
4. Discuss the ECG results, comparing the two ECGs.
5. What are the causes of atrial fibrillation?
6. How would you manage atrial fibrillation:
a) if blood pressure is stable?
b) if blood pressure is unstable?
7. How would you manage his respiratory distress?
8. What are the causes of renal dysfunction?
9. Discuss your perioperative management of the patient if he was on your list.
10. Would he benefit from preoptimisation?