Description

Case 1

A 16 year old boy is hit by a car and is admitted with severe pulmonary contusions and bilateral pneumothoraces. Bilateral chest drains are inserted and removed after 72 hours since they were not bubbling.

The following day he became hypoxic, his Fi02 and his airway pressures rise. A CXR is taken (Figure 1), the ICU registrar diagnoses a pneumothorax and inserts a chest drain (Figure 2) but without any clinical improvement.

Q 1.

Describe the CXR in Figure 1 and 2.

Q 2.

What is the diagnosis and what signs on the CXR should have alerted the ICU registrar to this diagnosis instead of a pneumothorax.

Q 3.

What treatment should be performed immediately?

Case 2

A 74 year old lady presents for elective inguinal hernia repair. She has a history of angina, well controlled on Amlodipine and has occasional dizzy spells. Her 12 lead ECG is shown (Figure 3).

Q 1.

What is the diagnosis on this ECG?

Q 2.

What are her dizzy spells due to?

Q 3.

What treatment do you recommend?