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Final clinical short case 34

Created: 5/4/2012
1. You are presented with an ECG at the pre-assessment clinic for a patient booked for elective surgery.
- What does this 12-lead ECG show?
- What are the causes of atrial fibrillation?
- What further information would you like?
- This patient’s blood pressure is 135/90 mm/Hg. How would you manage this?
- Under what circumstances would you expect cardioversion to be successful?

2. You are inserting a lumbar epidural for a 25-year-old woman in labour and you unfortunately perform a dural tap. Discuss your immediate management.
- Discuss the symptoms of a post-dural puncture headache (PDPH).
- How do you treat PDPH?
- Describe how you would perform an epidural blood patch.

3. You are called urgently by the renal SpR for a patient who is acutely short of breath following a failed attempt at insertion of a Vas Cath into the right internal jugular vein. The patient is 55 years old, obese and has a history of chronic renal failure. He is audibly stridulous and has a large haematoma on the right side of his neck. He is very tachypnoeic and is struggling to breathe.
- What do you think has happened?
- What is your management plan?
- What will you have to consider in view of his chronic renal failure?

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