Thoracic Trauma, Pericardial Pathologies, and Thoracoabdominal Aortic Emergencies — WACS Viva & Clinical Scenarios (Cardiothoracic)

Exam-style thoracic trauma, pericardial pathologies, and thoracoabdominal aortic emergencies viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 30-year-old male (ASA V E) presents with a stab wound to the left parasternal 4th intercostal space. He is restless, pale, with a blood pressure of 60/40 mmHg, HR 135 bpm, distended neck veins, and muffled heart sounds. Outline your immediate resuscitative and anaesthetic management for an emergency sternotomy/thoracotomy.
• SCENARIO 2: A 45-year-old male with confirmed chronic tuberculous constrictive pericarditis is scheduled for elective radical pericardiectomy. Describe the pathophysiological abnormalities (ventricular interdependence, diastolic filling impairment) and your anaesthetic management before, during, and after pericardial stripping.
• SCENARIO 3: A 28-year-old female polytrauma victim from an RTC presents with a severe right-sided flail chest, extensive bilateral pulmonary contusions, and an SpO2 of 78% on room air. How do you assess her respiratory mechanics, formulate an intubation strategy, and set lung-protective ventilation parameters?
• SCENARIO 4: A 58-year-old hypertensive male (ASA IV E) presents with sudden tearing interscapular back pain, severe hypertension (BP 210/110 mmHg), and a wide mediastinum on chest radiograph, diagnosed with Acute Stanford Type A Aortic Dissection. Outline your haemodynamic goals and anaesthetic protocol for emergency repair on CPB with deep hypothermic circulatory arrest (DHCA).