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Final clinical long case 21

Created: 24/5/2007
A 56-year-old coal miner requires sigmoid colectomy for carcinoma. He has a home nebuliser. His FEV1 is 0.68 litres, and he has 3% reversibility with salbutamol.

Shortness of breath 50 yards.
Wheezy chest
Respiratory rate 30/min
Non-productive cough
Chest X-ray: bullous lung disease and prominent pulmonary arteries
ECG: normal
Saturations: 93% on air. PO2 12 kPa; PCO2 4.5 kPa
No electrolytes

He is currently taking 2.5 mg prednisolone (the dose was recently reduced)

1. Summarise the case.
2. What are the main issues?
3. How would you optimise this patient preoperatively?
4. What is the likely cause of his COPD?
5. Present the chest X-ray.
6. What are the chest X-ray findings in pulmonary hypertension?
7. Present the ECG.
8. What ECG findings might you find?
9. What are the ECG changes seen in heart strain (left and right)?
10. What are the criteria for pathological Q waves?
11. What is respiratory failure?
- Give blood gas definitions of type 1 and 2 respiratory failure
12. What are blue bloaters and pink puffers?
- Which is this patient?
13. How would you anaesthetise this man?

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