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Final clinical short case 14

Created: 13/7/2005
1. A female patient has had an anaphylactic reaction. You have dealt with the initial crisis.

- What further action would you take?
- Who should perform the skin prick testing?
- If the same patient were to present for appendicectomy before these test have been carried out, how would you manage this?
- What is the evidence for premedicating with an antihistamine in these circumstances?
- Which induction agent is least likely to cause anaphylaxis?
- How would you recognise anaphylaxis if the patient is anaesthetised?
- If this patient were to present for a leg operation (e.g. for debridement) rather than an appendicectomy, how would you anaesthetise her?

2. A 36-year-old female with a history of ulcerative colitis presents with toxic megacolon.

- What are the problems you might encounter?
- What investigations would you request?
- What drugs are such patients commonly taking?
- What problems might be caused by these drugs?
- How would you anaesthetise this patient?
- What drugs would you avoid in this type of patient?
- What are the pros and cons of epidural analgesia in such a patient?

3. A patient presents for a day case laparoscopy.

- How would you provide antiemesis?
- Why is this important?
- Discuss your anaesthetic technique.
- Which volatile anaesthetic is most likely to cause emesis?
- How would you guarantee that emesis is avoided?
- List some antiemetic agents. Where do they act?

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