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Final clinical long case 30

Created: 19/6/2009
An 89-year-old female presents for elective decompression of C3-5 for spinal stenosis. She has advanced rheumatoid arthritis and pain and paraesthesia in both arms.

Drug history

Few crepitations at right base.

White blood cell count (WCC): 17 x 109/L
Haemoglobin: 9.7 g/dL
Urea: 8.7 mmol/L
Creatinine: 100 µmol/L
Pulmonary function tests: restrictive picture
Chest X-ray: Fibrosis, lower lobe collapse

1. What are the causes of the high WCC?
2. Why is she anaemic?
3. What type anaemia does she have?
4. Would you transfuse her preoperatively?
5. Discuss her pulmonary function test results. How do they fit with her history? What are the side effects of sulphasalazine and prednisolone?
6. How would you assess and manage her airway? What other techniques are there for managing her airway?
7. How do you know if someone is safe to extubate?

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