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By Garrioch, Magnus

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Ii. Why does a full N2O cylinder (with a lower pressure) contain more molecules of gas/vapour than a full oxygen cylinder (with a higher pressure)? iii. Do the pressure gauges indicate how much of the contents remain? Explain why or why not. The fact that N2O is not an ideal gas at room temperature explains this. What is an ideal gas, and why is N2O not ideal at room temperature? iv. Will the cylinder pressures change with altitude and temperature? v. What percentage of N2O content remains when the delivered pressure starts to decrease?

Radial nerve: extension of the elbow, extension and abduction of the wrist radially, extension of the fingers. indd 44 15/10/14 11:37 AM QUESTION 33 33 A plethoric 48-year-old man with severe ischaemia of his right foot scheduled for below knee amputation is shown (33). He smokes 40 cigarettes per day and suffers occasional tight chest pain that he has never reported. His haemoglobin (Hb) level is 190 g/l (19 g/dl). i. What is the most likely diagnosis? ii. Why does plethora occur? iii. Why is it important to note his plethora, and how would you investigate it?

Once the INR is under 2, an alternative perioperative prophylaxis should be started. 5. 5 times normal. The infusion should be stopped no sooner than 6 hours before surgery and restarted 12 hours afterwards. This should be continued until warfarin is restarted and the INR is above 2. Additional methods of prophylaxis include compression stockings and intermittent pneumatic compression devices. In emergency surgery there is not enough time for warfarin’s effects to wear off and haematology advice should be sought.

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