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Final clinical short case 38

Created: 11/3/2014
1. You are asked to interpret an ECG showing atrial fibrillation (AF) with fast ventricular response.
- Discuss the signs of haemodynamic compromise.
- Discuss perioperative management.
- Would you anaesthetise a patient with fast AF? What would you do if it occurred intraoperatively in association with profound hypotension?
- How would you anaesthetise for an elective cardioversion?

2. A chronic obstructive pulmonary disease (COPD) patient on the medical ward is referred to you by the medical registrar for respiratory failure.
- Describe how you would assess this patient.
- What are the indications for intubation and ventilation?
- Discuss the medical management for respiratory failure.
- What are the interim measures before intensive care?
- What are the indications and contraindications of non-invasive ventilation?

3. How would you anaesthetise a patient with known AIDS for a Hickman line placement?
- Discuss assessment, viral load, CD4 count and implications, and possible treatments they may be taking.
- What are the indications for Hickman line placement?
- What are the universal precautions that should be taken?
- Describe the needlestick injury protocol.
- Discuss the risks of transmission of HIV.
- Discuss screening for other blood-borne viruses.
- What is post-exposure prophylaxis?

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