AnaesthesiaUK Final Long Case-Nov.

MDMZ

An 80-year-old female presents for elective laparoscopic fundoplication for a hiatus hernia. She has a 3-day history of vomiting, dehydration, electrolyte imbalance (low potassium and low magnesium) and epigastric discomfort. She has recent-onset atrial fibrillation following an upper respiratory tract infection, and is currently digitalised.

Past medical history: Diverticulitis; hypertension
Medication: Enalapril; digoxin
Chest X-ray: Fluid level (hiatus hernia) + collapse
ECG: Sinus 95; left ventricular strain; widespread T inversion
Urea & electrolytes as above; normocytic anaemia; raised white cell count and C-reactive protein

Questions
1. What is the differential diagnosis of epigastric discomfort?
2. What does the ECG indicate?
- Describe the signs, symptoms and management of digoxin toxicity.
- What is the mechanism of action of digoxin?
- What are the American Heart Association cardiac risk factors?
3. What are the different types of hiatus hernia?
4. What is the differential diagnosis for anaemia?
- What are the transfusion guidelines of the Association of Anaesthetists of Great Britain and Ireland (AAGBI)?
5. Discuss the assessment and management of dehydration and electrolytes.
6. Describe the cardiovascular effects of laparoscopy.
7. Describe a plan for induction and monitoring.
8. Discuss the management of hypotension at induction.
9. Discuss the management of postoperative bradycardia, and hypoxia in recovery.

王麻子

I have some suggestions:
1,we can discuss it some questions in english, but we just know a few words to describe it, so if the writer has the standard answer. you can put it on.
2,From this situation, we also study the case.
Thanks.

shenxiu2

Unfortunately #1 does not have the model  answer for this question. So we will just have to  work out the answer ourselves.
You may give a try.
We can also use mixed language ( English + Chinese)  if you do not know the term in English.We will learn together.