Scenario 1

You are a resident medical officer working in the anaesthetics department. Your next patient is 26 year old Emily Brown. She is booked for a exploration laparotomy due to recurrent pelvic pain the following day. Please take a focused anaesthetics history and brief examination with a view to assessing her fitness for surgery and ease of intubation.

History Name, DOB Past medical history Past surgical history Past anaesthetic history Family history problems with anaesthetic malignant HTN, hypotension etc. Medications Allergies Examination Neck mobility Jaw mobility, jaw thrust Thyromental distance Heart sounds Chest auscultation Visualises mouth mallampati, dentures

Thyroid, Epilepsy, Heart, Respiratory, Reflux problems Teeth dentures, loose teeth Cervical stiffness/spondylosis Sys Rx: Chest pain, dyspnoea Exercise tolerance

History Name, DOB Past medical history Past surgical history Past anaesthetic history Family history problems with anaesthetic malignant HTN, hypotension etc. Medications Allergies Examination Neck mobility Jaw mobility, jaw thrust Thyromental distance Heart sounds Chest auscultation Visualises mouth mallampati, dentures History Name, DOB etc Past medical history Past surgical history Past anaesthetic history Family history problems with anaesthetic malignant HTN, hypotension etc. Medications Allergies Examination Neck mobility Jaw mobility, jaw thrust Thyromental distance Heart sounds Chest auscultation Visualises mouth mallampati, dentures

Thyroid, Epilepsy, Heart, Respiratory, Reflux problems Teeth dentures, loose teeth Cervical stiffness/spondylosis Sys Rx: Chest pain, dyspnoea Exercise tolerance

Thyroid, Epilepsy, Heart, Respiratory, Reflux problems Teeth dentures, loose teeth Cervical stiffness/spondylosis Sys Rx: Chest pain, dyspnoea Exercise tolerance

Scenario 2

You are a GP in a country practice. Your next patient is a 33 yr old police officer who has come in for removal of stitches. They have recently moved to the area. The notes from the previous practice indicate she was diagnosed with essential hypertension two years ago and was commenced on perindopril. The most recent investigations indicate normal renal function, lipid profile and fasting blood sugar. Last week when seen for the laceration the BP was noted to be increased. Today the nurse taking out the sutures has noted the BP to be 165/100mmHg and asked you to see her. The patient told the nurse she hadnt been taking the medication for a long time. Explore the patients medication compliance Explore patients understanding of the condition & discuss associated risks of untreated hypertension Counsel the patient appropriately (NOT ON SMOKING/ALCOHOL)

Expectations Seek agreement to discuss BP and treatment Ask questions to develop understanding of non-compliance Explore knowledge and attitude to hypertension and need for medication Explain why it is important to control BP and take medication Indicate that risk of future CV events will be lessened if BP is lowered Ask about thoughts, feelings and attitudes towards taking tablets, and what would motivate you to take them Work towards an agreement to restart the medication and on strategies for future health management Expectations Seek agreement to discuss BP and treatment Ask questions to develop understanding of non-compliance Explore knowledge and attitude to hypertension and need for medication Explain why it is important to control BP and take medication Indicate that risk of future CV events will be lessened if BP is lowered Ask about thoughts, feelings and attitudes towards taking tablets, and what would motivate you to take them Work towards an agreement to restart the medication and on strategies for future health management

Expectations Seek agreement to discuss BP and treatment Ask questions to develop understanding of non-compliance Explore knowledge and attitude to hypertension and need for medication Explain why it is important to control BP and take medication Indicate that risk of future CV events will be lessened if BP is lowered Ask about thoughts, feelings and attitudes towards taking tablets, and what would motivate you to take them Work towards an agreement to restart the medication and on strategies for future health management