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Final clinical long case 56

Created: 15/5/2015
A 16-year-old girl presents for cervical lymph node biopsy. She has a 1-month history of exertional dyspnoea, and cannot lie flat.

White blood cell count: 17  106/ml
Haemoglobin: 13 g/dl
Platelets: 210 x 109/L
Chest X-ray and CT scan shows almost complete compression of the trachea.

1. Discuss her preoperative, intraoperative and postoperative management.
2. Discuss her history and examination results.
3. Discuss regional anaesthesia (superficial and deep cervical plexus blocks) versus general anaesthesia options - gas induction or rigid bronchoscopy.
4. This patient is admitted to ITU. When would you extubate?
5. Her potassium level rises to 7.0 mmol/L post chemotherapy. What are the causes and treatment.
6. Discuss tumour lysis syndrome.

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