case discussion

hi, here I post this case for open discussion. let us think together and try to answer these questions. I am waiting for your valuable contributions.


A 56-year-old coal miner requires sigmoid colectomy for carcinoma. He has a home nebuliser. His FEV1 is 0.68 litres, and he has 3% reversibility with salbutamol.

Observations/examination Shortness of breath 50 yards. 
Wheezy chest 
Respiratory rate 30/min 
Non-productive cough 
Chest X-ray: bullous lung disease and prominent pulmonary arteries 
ECG: normal 
Saturations: 93% on air. PO2 12 kPa; PCO2 4.5 kPa 
No FBC 
No electrolytes 

Drugs 
He is currently taking 2.5 mg prednisolone (the dose was recently reduced) 

Questions 1. Summarise the case. 
2. What are the main issues? 
3. How would you optimise this patient preoperatively? 
4. What is the likely cause of his COPD? 
5. Present the chest X-ray. 
6. What are the chest X-ray findings in pulmonary hypertension? 
7. Present the ECG. 
8. What ECG findings might you find? 
9. What are the ECG changes seen in heart strain (left and right)? 
10. What are the criteria for pathological Q waves? 
11. What is respiratory failure? 
- Give blood gas definitions of type 1 and 2 respiratory failure 
12. What are blue bloaters and pink puffers? 
- Which is this patient? 
13. How would you anaesthetise this man? 

ArticleDate:20070524