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Final clinical short case 20

Created: 24/5/2007
1. An 8 year old girl fails to breathe after appendicectomy.
- What are the possible causes?
- How could you tell if this was due to muscle relaxants?
- What might you see with a nerve stimulator?
- What is a phase 1 block?
- What is a phase 2 block?
- What type of drug is dibucaine?
- What are normal and abnormal dibucaine numbers?
- Discuss the genetics of suxamethonium apnoea.
- For how long would this patient be apnoeic?
- How would you treat the patient?

2. You are shown an X-ray of a fractured mandible.
- Present the X-ray.
- Surgeons tell you to take the patient to the operating theatre within the hour. What will you do?
- What would make this case an emergency?
- How would you anaesthetise the patient?
- What are the Difficult Airway Society guidelines with respect to gas induction?
- How would you go about this procedure?
- What might be your major concerns?
- What antiemetics would you use?

3. A 23-year-old primigravida requires emergency lower segmental caesarean section (LSCS).
- It is a grade 1 category section, what would you do?
- What are the different grades of LSCS?
- Discuss the advantages and disadvantages of general anaesthesia versus spinal anaesthesia.
- Discuss the preoperative assessment en route to theatre with the patient in the left lateral position and receiving oxygen
- Discuss appropriate premedication
- Discuss the techniques for rapid sequence induction of anaesthesia.
- Discuss spinal anaesthesia and the doses that are used.
- Why is thiopentone used for rapid sequence induction?
- Which volatile anesthetics do you use and why?
- What is you opinion of the use of desflurane?

4. What are the safety features of the modern anaesthetic work station?
- Describe what you know about vaporisers.
- Discuss the use of plenum and draw-over vaporisers. Have you ever used a draw-over vaporiser?
- Discuss the Interlink 25, hypoxic guards, and Richie whistles.

5. Draw a cross-section of the spine at C6.

6. How do antiemetics work?
- What receptor types are found at each area?
- Where are the CRTZ, and the VC?
- What antiemetics do you use?
- Describe the mechanism of action of dexamethasone.

7. What is the stress response?

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