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Final clinical short case 17

Created: 14/3/2006
Updated: 14/3/2006
1. While administering an epidural for analgesia in a woman in labour with a 16-gauge Tuohy needle, a dural tap occurs.
- What are the reasons for a patient developing a headache after a dural tap?
- What percentage of patients will develop a postdural puncture headache (PDPH)?
- What are the risk factors which predispose to PDPH?
- What would be your further management?
- Would you administer another epidural or insert a spinal catheter?
- What are the advantages and disadvantages of these two techniques?
- Are there any other problems associated with the spinal catheter?
- How would you diagnose Cauda equina syndrome?
- What are the characteristics of PDPH?
- How is it treated?
- Can you use caffeine therapy in a woman who is breast-feeding?
- Would you use an epidural blood patch?
- At what stage would you administer this?
- How is this administered?
- Will you repeat it?
- How would you advise the woman about her future pregnancy?
- Is a future epidural likely to be as good/bad as this one?

2. How would you anticipate a difficult intubation?
- Describe the Mallampati classification.
- ? Sensitivity and specificity of MPC and others like Patils, Callders, Wilsons
- What equipment would you keep ready in the operating theatre?
- What types of blades would you have ready?
- How would you manage a patient who can be ventilated but cannot be intubated?

3. A patient in the recovery room, who has undergone a hysterectomy, is confused.
- What is your differential diagnosis and management?
- What are the usual causes for this (including drugs)?
- The patient is hypotensive and tachycardic; how would you manage this?
- Her ECG shows supraventricular tachycardia. How will you manage this?

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