Anaesthesia by Garrioch, Magnus

By Garrioch, Magnus

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21a i. How would likely injuries be predicted? ii. What are the immediate priorities when dealing with this patient? iii. What does the radiograph show? iv. What other investigation needs to be carried out to confirm or refute the potentially life-threatening provisional diagnosis? indd 27 15/10/14 11:37 AM Answer 21 21i. The mechanism of injury predicts likely pathology. Severe injuries (head, neck, thorax, abdomen, pelvis and limb) can be sustained by an unbelted front seat passenger who collides with the dashboard of the car at 40 mph (64 kph).

Indd 53 15/10/14 11:37 AM Answer 40 40 In the ‘ideal lung’ PaCO2 and ETCO2, ventilation and perfusion should match exactly with a ratio of 1. e. a spread of V/Q ratios) leads to alveolar dead space and a difference between PaCO2 – ETCO2. Two factors are important here: • Gravity causes variation in alveolar size. At end-expiration, dependent alveoli and airways are ‘squashed’, while non-dependent alveoli/airways are relatively expanded. Thus they fill and empty asynchronously and the overall effect is V/Q <1.

This patient should have additional antihypertensive medication started (either calcium channel blockers or beta-blockers, but not both). indd 36 15/10/14 11:37 AM QUESTION 26 26 The molecule structure of a muscle relaxant drug is shown (26a). (CH3)3 N CH2 CH2 O C CH2 CH2 C O CH2 CH2 26a N (CH3)3 O N+ O O N+ – 2Cl O i. What is the drug? ii. How does this drug work? iii. Why is it short acting? Explain why, rarely, in some individuals it can last for a long time. iv. Can this drug be used within 24 hours of a 30% body surface area burn?

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