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Final clinical long case 24

Created: 16/4/2008
 
A 67-year-old female patient presents for an Austin-Moore hemiarthroplasty.

History:
The patient has previously undergone aortic and mitral valve replacement for rheumatic heart disease. She is currently suffering from shortness of breath on exertion, and has fallen and sustained a fractured neck of femur.

Medications:
Warfarin
Digoxin
Spironolactone
Bumetanide
Lisinopril

Blood results:
Haemoglobin 10.1 g/dl
Platelets 238 x 109/L.
white blood cell count 3.4 106/ml
Na+ 130 mEq/L
K+ 4.9 mEq/L
Urea 14.6 mmol/L
Creatinine 175 µmol/L
INR: 3.6

Observations/examination:
ECG: left bundle branch block; nodal rhythm of 100/min; left ventricular hypertrophy
Chest X-ray: cardiomegaly; pulmonary oedema; pulmonary hypertension

Questions
1. Summarise the case.
2. Comment on the investigations.
3. What sort of drugs is she on?
4. Would you anaesthetise her, and, if not, how would you optimise her?
5. What would be your anaesthetic technique when she is optimised?


ArticleDate:20080416
SiteSection: Article
 
   
    
                                            
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