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Final clinical short case 35

Created: 17/5/2012
1. Describe Bier’s block for Dupuytren's contracture.
- How would you explain the procedure to the patient?
- What are the contraindications?
- Explain the technique
– Why would you want intravenous access in both hands?
- What dose of prilocaine would you use?
- Why would you not use why not bupivicaine?
- What problems might you encounter, and how would you treat them?
- What would happen if the cuff deflated?
- Discuss local anaesthetic toxicity and its treatment.
- Who were Bier and Eschmann?

2. A rheumatoid arthritis patient presents with stridor, and requires a general anaesthetic. You are shown her lateral C-spine film, which shows a fixed c-spine (C2,3,4).
- Explain why this might be the case.
- How would you anaesthetise her?
- What are the anaesthetic options?
- Describe the awake fibreoptic technique and the use of the laryngeal mask airway.

3. Discuss the effects of hypothermia.
– What are the effects of different temperatures on the cardiovascular system and respiratory system?

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