ExAC case studies
ExAC · Put your knowledge to work in context.
ExAC is a multiple-choice certification-style examination in airway and critical-care practice. It is aimed at clinicians and advanced practitioners who manage airways, ventilation, hemodynamics, sedation, and peri-procedural risk in acute or procedural settings - for example anesthesia providers, emergency and critical care clinicians, respiratory therapists, and advanced practice nurses whose scope includes airway rescue and procedural sedation. The ExAC case studies are 5 cases and about 4,608 words.
1Failed airway, falling saturation, radiated neck
A 58-year-old man (BMI 41, weight 122 kg) presents for urgent laparoscopic cholecystectomy with 12 hours of fever and right upper quadrant pain. Four years ago he had laryngeal cancer treated with 60 Gy external-beam radiation to the neck.
902 words, about 5 min2Desaturation during one-lung ventilation
66-year-old woman, 160 cm and 78 kg, former smoker with FEV1 78% and DLCO 68% predicted, scheduled for right upper lobectomy through a thoracotomy. After induction a 35 Fr left-sided double-lumen tube is placed, and fiberoptic bronchoscopy confirms the bronchial cuff in the left main bronchus with the carina above the tracheal cuff.
921 words, about 5 min3Hypotension and bradycardia after spinal anesthesia for hip fracture
74-year-old woman, 62 kg and 155 cm, admitted with a displaced femoral neck fracture after a fall at home; surgery is scheduled for the next morning. History: hypertension treated with atenolol 50 mg daily and ramipril 5 mg daily (ramipril withheld on the morning of surgery, atenolol continued), no angina, NT-proBNP 320 pg/mL, creatinine 118 micromol/L.
953 words, about 5 min4Sedation for colonoscopy in untreated obstructive sleep apnea
45-year-old man, 178 cm and 114 kg (BMI 36), STOP-BANG score 6, never had a sleep study, scheduled for outpatient colonoscopy under anesthesiologist-administered propofol sedation. He took no sedative premedication.
920 words, about 5 min5Reversal after profound block in renal impairment
62-year-old woman, 95 kg, BMI 34, type 2 diabetes and CKD stage 3b (eGFR 30 mL/min/1.73 m2), scheduled for laparoscopic hysterectomy. Anesthesia includes rocuronium 0.6 mg/kg (57 mg) at induction, then two maintenance doses of 10 mg, the last 45 minutes before the end of surgery.
912 words, about 5 min