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Final clinical long case 8

Created: 7/4/2004
You are presented with a 70-year-old man 4 days postoperatively after an abdominal aortic aneurysm repair. He has a complicated past medical history, which is as follows:

- Hypertension 1991
- Transient ischaemic attack (TIA) 1997
- Type 2 diabetes 1998
- Shortness of breath on exertion (SOBOE) 2000

He has presented to A+E with sudden onset shortness of breath. You, as the ITU registrar, are called down to assess him. His chest X-ray has shown pulmonary oedema, cardiomegaly and right lower lobe collapse with tracheal deviation. His ECG has shown atrial fibrillation (AF) with myocardial ischaemia.


1. Please talk in depth about the management of AF in intensive care.
2. Which drugs would you use to treat his AF?
3. What are the causes of AF?
4. How would you identify the causes in this situation?
5. How would you manage this case?

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