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Final clinical short case 32

Created: 3/6/2011
1. An 8-year-old is admitted unconscious into A&E following a road traffic accident in which he sustained an open compound tibia/fibula fracture.

- Describe your management.
- What investigations would you perform?
- His CT shows cerebral oedema only. Orthopaedic surgeons want to take him to theatre to repair his fracture. How would you anaesthetise him?

2. You are shown an ECG of a 35-year-old presenting for elective surgery. His ventricular rate is 61 bpm, there are normal QRS complexes but the PR intervals are getting progressively shorter, followed by a missed beat (only one on rhythm strip II).

- Describe the ECG.
- What are the symptoms of complete heart block with this ventricular rate?
- Describe your management.
- Where do you think the block lies in this patient?
- What are the causes?

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