# Case set 03: educational synthesis

> **Educational work by a pre-medical student — not medical advice.** Not a clinical protocol, prescription, or patient handout, and not for patient care. See [DISCLAIMER](DISCLAIMER.md).

Revised 27 October 2026. This summary follows the corrected [case bank](case_set_03_postoperative_cardiothoracic_scenarios.md). It supplies no separate medication, device or escalation instructions.

- Scenario 1: **CABG with vasoplegia, hypothermia and bleeding**. A preserved EF does not exclude important low-output physiology, and hypothermia should not be assumed to cause vasodilation.
- Scenario 2: **VA-ECMO with rising lactate**. A transmembrane gradient alone is not an oxygenator-change rule; interpretation belongs to the ECMO team.
- Scenario 3: **LVAD with RV dysfunction**. Device alarms and displayed flow do not establish a unique diagnosis or universal speed adjustment.
- Scenario 4: **ARDS after supination**. A mode switch alone does not cap injurious lung stress. No universal pH or driving-pressure trigger for ECMO is prescribed.
- Scenario 5: **Aortic repair with new pain and oliguria**. This is a prompt for urgent expert evaluation, not a sequence of fluids followed by imaging only if a numerical target fails.
- Scenario 6: **Early lung-graft dysfunction**. No graft diagnosis, PEEP range or ECMO threshold follows from this short vignette alone.
- Scenario 7: **Abdominal sepsis with refractory shock**. Laboratory values and positive balance do not alone establish a dialysis indication or an ultrafiltration rate.
- Scenario 8: **SAH with cardiac dysfunction**. A preselected MAP or sodium range is not a validated plan for every SAH patient.

## Reflection

For each scenario, separate observed fictional facts from hypotheses; identify missing data; explain one alternative mechanism; and cite a source with its population and limits. Do not treat a successful exercise as clinical competency or institutional approval.