|1. Simulator manikin
Demonstrate tracheostomy change in a patient with a well-formed stoma in the ICU (including removal of introducer).
- What are the potential complications?
Discuss the anatomy of the brachial plexus.
- Which nerve supplies the triceps muscle?
3. Simulator manikin
Demonstrate synchronised shocking of an anaesthetised patient in ventricular tachycardia (VT)
- How many attempts at synchronised cardioversion are permitted?
- what therapy might be considered if this fails?
Examine the airway in a patient with extremely limited neck movement (in both the vertical and lateral planes.
- You are shown an X-ray of the C-spine. Point out the atlanto-occipital junction.
- Is the X-ray normal? (Patient had anterior subluxation of C5 on C6)
5. Communication skills
You are presented with a patient with a subdural puncture headache on day 1 post-partum following an epidural. She is anxious and in pain and remembers nothing of the pre-procedure explanation.
- Explain the risks of a blood patch. What will you say to the patient if she asks if the dural puncture could occur again?
You are shown graphs of current versus time: point out cutting and coagulation graphs
- What is the current density?
- What is the difference between mono- and bipolar diathermy?
- What are the risks of diathermy? At which frequency is the risk highest?
- What frequency is used?
You are shown an ultrasound image of the internal jugular vein and internal carotid artery.
- On which side of the patient was the picture taken?
- Name four ways of telling 'clinically' that 'you are in the vein'.
You’re shown a rhythm strip showing sinus bradycardia (in the context of a patient anaesthetised in theatre) and asked to interpret it.
- Describe the adult bradycardia algorithm.
9. History taking
Take a history from a patient presenting for retinal surgery under general anaesthetic.
10. Simulator manikin
You are called by a more junior anaesthetic trainee to see a 16-year-old who has just been induced with sevoflurane and vecuronium and is now desaturating. Demonstrate how you would manage the patient
You are shown a CT scan reconstruction of the skull/face showing facial fractures. The left side of the scan is not fully seen (i.e. off the edge of the screen).
- Is this a fractured left zygoma?
- Could you give this patient suxamethonium?
- Could this patient develop a divergent squint?
Demonstrate insertion of RIJ CVC using the Seldinger guidewire technique.
- What are the immediate complications?
- What are the contents of the carotid sheath?
You are shown a colour picture of foetal circulation.
- Name the obsolete ligament in adults.
- What causes closure of the foramen ovale?
- Name the ring structure containing the umbilical vessels.
14. History taking
Take a history from a lady presenting for abdominal hysterectomy. She is very quiet and not very forthcoming. On questioning her, it sees that she is having the surgery because of heavy menstrual bleeding. She has been on iron for the past 11 years. It then transpires that the patient has thalassaemia.
- What other condition might the patient have?
- How is thalassaemia inherited?
- What are the chances that one of her children has inheriting the condition?
You are shown a chest X-ray showing cardiomegaly and asked to interpret it. The patient’s history included a pan systolic murmur and shortness of breath.
- You are asked questions on digoxin toxicity.
You are shown a photograph of suction apparatus, as would be found on an anaesthetic machine, and are asked to study it for about 10 seconds. You are then asked:
- On which side does maximum suction occur?
- How much negative pressure is generated?
- You are shown a second picture: how is this apparatus different from the first?
- Name three means by which you can generate negative pressure.
You are shown a photograph of an entonox cylinder and are asked to identify it.
- At what pressure is the gas inside the cylinder?
- What is the Poynting effect?
- What is pseudocritical temperature and what is its relationship with ambient pressure?
- Who can administer entonox?
- Why is it not used on normal wards?
- Who would you not administer entonox to?