Clinical Viva 4
You have 10 minutes to study the case history, CXR, ECG, investigations.
A 64 year old man is undergoing right total hip replacement.
- He gives a history of asthma and chest pain.
- He is taking oxitropium bromide.
- He has been hospitalised 3 times for chest pain.
- The last hospitalisation was 6 months ago.
- He has a history of deep vein thrombosis after a previous operation and took Warfarin, which was stopped 3 months ago.
- He also has history of hiatus hernia, diagnosed after oesophagoscopy.
- He is moderately obese; his weight is 95 kg, his height is 1.65 cm.
- Apart from bilateral basal crepitations and diffuse wheezing, all over both lung fields are normal; first and second heart sounds normal, apex beat is not displaced.
- Blood pressure is 140/90 mmHg.
- Full blood count - NAD
- Lung function test - FEV1 - 65% of predicted value. FEV1/FVC - 50%. PEFR - 70% of predicted value.
- ECG - Bifacicular block. Inverted T waves in Leads 1, AVL, V1 to V4.
- CXR - shows minimal basal effusion. Lungs are not hyperinflated.
1. Summarise the case
2. Interpret the data
3. What further investigation would you carry out?
4. How would you anaesthetise this patient?
5. How would you prevent DVT?