Perioperative Fluid Kinetics, Acid-Base Management, Blood Conservation, and Massive Transfusion — WACS Viva & Clinical Scenarios (General Anaesthesia)

Exam-style perioperative fluid kinetics, acid-base management, blood conservation, and massive transfusion viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 32-year-old male is brought to the operating theatre for emergent laparotomy following a high-speed road traffic accident with a shattered spleen and retroperitoneal haematoma. Heart rate is 142 bpm, BP is 70/40 mmHg, haemoglobin is 5.2 g/dL, and he is oozing from puncture sites. Detail your immediate haemostatic resuscitation and massive transfusion protocol.
• SCENARIO 2: A 55-year-old male with a history of hypertension undergoes a 6-hour open major hepatectomy. He receives 7 litres of 0.9% normal saline intraoperatively. At the end of surgery, his ABG reveals: pH 7.21, PaCO₂ 36 mmHg, HCO₃⁻ 14 mmol/L, Base Excess -11 mmol/L, Na⁺ 148 mmol/L, Cl⁻ 118 mmol/L, K⁺ 5.4 mmol/L, Lactate 1.8 mmol/L. Diagnose the acid-base disorder, explain its pathophysiology, and discuss its clinical consequences.
• SCENARIO 3: A 62-year-old female is scheduled for major spine surgery with expected blood loss >2000 mL. Banked blood is severely limited in your hospital. Detail your multi-modal blood conservation strategy across the preoperative, intraoperative, and postoperative phases.
• SCENARIO 4: You are managing an intraoperative massive haemorrhage in a 28-year-old patient. The ROTEM/TEG trace reveals a prolonged Clot Time (CT) / Reaction Time (R-time), a reduced Alpha Angle, a severely depressed Maximum Clot Firmness (MCF) / Maximum Amplitude (MA), and significant Clot Lysis at 30 minutes (LY30 >15%). Interpret these viscoelastic findings and provide targeted pharmacological and blood-component therapies.