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Final clinical long case 44

Created: 24/8/2012
An 81-year-old man presents with left ventricular failure and surgical emphysema, shown on a chest X-ray. He has a history of vomiting and chest pain. His C-reactive protein is raised, he has a raised white blood cell count, bibasal crepitations and bronchial breathing on the left side. His arterial blood gases show respiratory acidosis, with a plasma CO2 tension of 8.9 mmHg and normal bicarbonate levels. The patient has surgical emphysema from a ruptured oesophagus and needs an urgent thoracotomy.

1. Discuss one-lung ventilation and checking the correct placement of double-lumen tube.
2. Discuss strategies for managing hypoxia under one-lung ventilation.

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