# Case set 04: 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_04_postoperative_hemodynamics_and_device_physiology.md). It supplies no separate medication, device or escalation instructions.

- Scenario 1: **CABG with low vascular tone**. No methylene-blue or vasopressor trigger is derived from one resistance or lactate number.
- Scenario 2: **Redo AVR with AKI and congestion**. A cardiac-index cutoff alone does not select an inotrope.
- Scenario 3: **Mitral surgery, bradycardia and delirium**. HFNC does not imply an endotracheal tube. An extubation SBT is not the corresponding readiness test. No atropine dose or pacing rule is supplied.
- Scenario 4: **Tricuspid repair and RV dysfunction**. Avoid blanket prohibition of PEEP or a fluid-removal rule based solely on CVP.
- Scenario 5: **Mechanical AVR and anticoagulation**. No universal INR range, warfarin hold or heparin instruction is supplied.
- Scenario 6: **CABG/MVR with pulmonary edema**. No automatic broad-spectrum antibiotic or fixed negative-fluid target is established.
- Scenario 7: **Post-Cox-Maze bradycardia**. No rate-only treatment threshold is supplied.
- Scenario 8: **LV aneurysmectomy with low output**. A low saturation or rising lactate is not by itself a milrinone or diuresis prescription.
- Scenario 9: **New postoperative fever**. Fever or procalcitonin alone neither proves infection nor chooses an antibiotic regimen.
- Scenario 10: **RV dysfunction after tricuspid repair**. No blanket beta-blocker prohibition, PEEP prohibition or SBT instruction is supplied.
- Scenario 11: **Bentall/hemiarch with mixed shock**. An INR value does not identify the prosthesis or establish the complete anticoagulation plan.
- Scenario 12: **Persistent congestion after CABG/AVR**. No escalating diuretic combination or dialysis instruction is supplied.
- Scenario 13: **Rising lactate after CABG/mitral repair**. A lactate cutoff is not a validated trigger for a particular inotrope.

## 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.