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Final clinical short case 39

Created: 25/4/2014
1. A woman who has undergone a hysterectomy for which you were the anaesthetist visits her GP 6 weeks later and complains that she was awake during her anaesthetic.

- How would you proceed?
- Define implicit versus explicit.
- What are the risk groups?
- How do you avoid it?
- What is likely to mask it?
- Why do we not recommend bispectral index (BIS) monitoring routinely?

2. A young male presents for open reduction and internal fixation (ORIF) mandible.

- When would you do this and how?
- How would you examine him?
- What are the associated injuries?
- What are the signs of a basilar skull fracture?
- How do you “clear” a C-spine
- How does the consumption of alcohol affect stomach emptying?
- How would you anaesthetise him?

3. An 80-year-old woman is brought to A&E unconscious.

- What are the possible causes?
- What are the clinical features of mild/moderate/severe hypothermia?
- What are the ECG findings of hypothermia?
- How would you warm such a patient (active/passive)?
- Where would you measure temperature?

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