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Oral case 26

Created: 4/10/2004

Management of epiglottitis

You are asked to consult on the care of a 4-year old with epiglottitis.

1. What problems may be encountered?

2. How would you manage problems?

3. What would your criteria for intubation be for a patient like this?

4. What would your criteria for extubation be for this patient?

Monitoring for end-tidal CO2

1. Does availability of end-tidal CO2 measurement remove the need for blood gas analysis? Explain.

2. Give specific applications of ETCO2, with methods of measurement.

3. Give guidelines for interpretation of results.

Nutrition and anesthesia

A cachectic 70-year old male with a partially obstructing colon carcinoma requires colostomy.

Intravenous alimentation has begun.

1. What is the significance of the nutritional state to anesthesia?

2. What is the significance of recently started hyperalimentation?

Complications: Sepsis, fatty acid deficiency, hyperglycemia, nonketotic hyperosmolar hyperglycemic coma, hypoglycemia, metabolic acidosis, hypercarbia, fluid overload, renal dysfunction, hepatic dysfunction and thrombosis of central veins.

Indication and management: Isovolemic hemodilution

1. What are its advantages and disadvantages in blood replacement?

2. How low can the hematocrit be allowed to fall?

3. How do you assess cerebral and/or myocardial ischemia?

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