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Primary Viva 19 (Clinical)

Created: 9/1/2007
A 68-year-old patient with insulin-dependent diabetes mellitus presents with septic shock and diabetic ketoacidosis for a below-knee amputation.

1. How would you proceed?
2. How would you resuscitate the patient?
3. What fluids would you administer?
4. How would you infuse insulin?
5. What investigations would you carry out and why?
6. Which antibiotics would you give?
7. Describe your management plan for the patient
8. You need to administer unilateral spinal anaesthesia; which drug would you use and at what dose?
9. If, 10 minutes after a successful block, the patient has convulsions, what would you do? What might be the causes?
10. Why might the patient suffer from hypoglycaemia during surgery?

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