Professional

Question 1

PROFESSIONALISM – INFORMED CONSENT

[21B09] Describe the elements of informed consent for anaesthesia (50%).
Discuss the informed consent process in the context of the following situations (50%):
- A 20yo primip in late first stage of labour requests epidural analgesia
- A 15yo is scheduled for posterior spinal instrumentation for severe idiopathic scoliosis.

Answer 1

PS 26
Element inf con

-legal requirement - consent - all med rx
- respect for auto and prov of rel info

3 important elements
1. Voluntary

2. Informed
   BRAN
3. Capacity
   - presumed capacuty
   - transient (sed/intox)
   - not binary
   *documentation

Labour epidural
- pain distracting, not fully informed
*best to provide ifo, but cont with procedure
- offer revisit post
- document of discussion occurred

15yo spinal for scoliosis
- risk of GA (high risk surgery)
- use of morbidity/mortality calculators
- risk of prone (visual loss/nerve damage)
- consenting teenager / guardian issues

Question 2

PROFESSIONALISM – Rational use of sugammadex

[21A07] Your department has exceeded its drug budget for the last financial year. You have been asked to develop a departmental policy document for the rational use of sugammadex.
Discuss the issues to be considered.

Answer 2

1. Clinical justification
   a) PORC
   b) rapid emergency reversal
   - CICO
   c) residual paralysis post neo
   - TOF still <2
   d) neo CI
   Abs - hypersen
   Rel - peritonitis/mech obs
   Cau - CAD, arry, ACS, MG, asthma, DMD
2. Economic justification
   - Waiting for TOF > 2
   - Cost of NMT devices

Question 3

PROFESSIONALISM - Fatigue

[20B13] You have been asked to formulate guidelines for your department on managing fatigue. a. List the hazards associated with fatigue in the practice of clinical anaesthesia.(30%)
b. Outline your guidelines and discuss the potential consequences of their implantation.(70%)

Answer 3

PS 43 - Fatigue

Question 4

PROFESSIONALISM – Substance abusing colleague
[20A07] You are concerned about the possibility of substance abuse by a consultant colleague. a. Describe the signs that are suggestive of substance abuse in a colleague.(50%)
b. Outline the steps that should be followed if this is suspected.(50%)

Answer 4

RD 20

Question 5

PROFESSIONALISM – Minimising surgical site infection

[19B10] Describe the role of the anaesthetist in minimising surgical site infection.

Answer 5

PS 28

Question 6

PROFESSIONALISM - Debriefing

[19B05] A patient dies soon after induction of anaesthesia. As a senior clinician you are asked to arrange a debriefing. Outline the considerations.

Answer 6

RD 05

Question 7

PROFESSIONALISM – MRI scanner

[19B04] Describe the requirements for establishing an anaesthetic service for a neurosurgical theatre with a magnetic resonance imaging scanner.

Answer 7

PS55 app 1 - emerg meds
PS07 PAC
PS04 PACU

1. Consultation
2. Design
3. Location
4. Equipment
5. MRI safe equipment
6. Emerg meds
7. Staff training
8. Pt screening
9. Contrast

Question 8

PROFESSIONALISM – PACU / discharge criteria

[19A06] Describe your responsibilities as the anaesthetist before you leave your patient in the post anaesthesia care unit (PACU). (50%)

Your patient has been in the PACU for an hour. The nurse asks you to change the discharge criteria so the patient can be discharged to the ward. Discuss your decision making process following this request. (50%)

Answer 8

PS53 - ho resp
PS04 - PACU