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Final clinical short case 50

Created: 18/10/2017
1. An 80-year-old man presents with an abdominal aortic aneurysm rupture. You are asked some questions about his management in A&E and how to induce anaesthesia. What is the patient’s likelihood of survival? He lost cardiac output briefly and had a reduced Glasgow Coma Scale (GCS) score; discuss the GCS scoring system. Postoperatively, what can cause rising lactate levels?

2. A patient’s ECG shows complete heart block in the preoperative clinic; what would you do? What are the causes? Discuss the issue of pacemakers in the operating theatre. What would you do if you suddenly saw the ECG trace in theatre?

3. A patient undergoing multiple normal vaginal deliveries under epidural analgesia becomes acutely short of breath. What are the causes? Discuss pulmonary embolism, amniotic fluid embolism and drug causes; how does ergometrine cause shortness of breath?

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