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Final clinical long case 27

Created: 30/10/2008
A 17-month-old boy is brought by his mother into A+E. The mother tells you that the child was eating Bombay mix about 2 hours ago and suddenly choked and then went blue. This lasted for a few minutes, after which the child went on to eat some chocolate and a banana. He subsequently started grunting.

Saturations: 94% on air
Pulse: 120 bpm
Red face
Grunting sound, harsh breath sounds on left-hand side of chest
Chest X-ray: lung hyperexpanded on right-hand side and some collapse on left-hand side

1. Summarise the case.
2. What are the important points in the history?
3. What is the grunting?
4. What is the problem with Bombay mix?
5. What is the significance of his red face?
6. Discuss the findings on the chest X-ray.
7. What needs to be done now?
8. How would you anaesthetise the child for bronchoscopy?
9. Would you consider premedication?
10. Discuss the merits of intravenous versus inhalational anaesthesia.
11. Describe how to perform an inhalational induction.
12. Describe the different ways in which to maintain anaesthesia.
13. Describe the different bronchoscopes.
14. Problems arise intraoperatively: the foreign body moves distally. What problems will this cause? What signs will you see?
15. What is your opinion on having the parents in the anaesthetic room?

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