Gen Surg

Question 1

GEN SURG – CO2 embolism

[21B04] Describe the clinical presentation of venous carbon dioxide embolism during laparoscopic surgery and outline your management.

Answer 1

differentiate b/w VAE!

CO2 microembolism occurs

Presentation
1. Gas exchange abn
- low O2, CO2, pH
2. Inc RV AL
3. Dec LV filling
- Dec CO/ LV failure / cardiac arrest

Mx
- Notify surgeons
- Desuffl
- Left lat decub
- 100% O2
- CVC
- HBOT

Question 2

GENERAL – ECG after LBO Laparotomy (inferior ischaemia)

[21A05] This is the standard 12-lead electrocardiogram (ECG) of a 56-year-old man in the post-anaesthesia care unit (PACU) two hours after an emergency laparotomy for bowel obstruction. He is complaining of SOB, abdominal pain and has a blood pressure of 160/110mmHg.
He has a history of hypertension controlled with atenolol and hydrochlorothiazide. The preoperative ECG is missing. The anaesthetic assessment only notes that it showed sinus rhythm.

Considering all the clinical information:
a) Interpret this ECG

b) Outline the appropriate management of this patient in PACU.

Answer 2

Interpret:

1. Mx of ischaemia
   MOAN
2. HTN mx
3. Imm post op
   - Thrombolysis less appropriate

Question 3

GENERAL – Autonomic dysreflexia

[19A08] A patient with previous spinal cord injury presents for ureteric stenting.

a) Discuss the pathophysiology of autonomic dysreflexia. (50%)

b) Describe the intraoperative manifestations and subsequent management of autonomic dysreflexia. (50%)