# Case set 05: 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_05_mechanical_support_and_goals_of_care.md). It supplies no separate medication, device or escalation instructions.

- Scenario 1: **Early low-output physiology**. No automatic decision to withhold diuresis or lower PEEP follows from RV dysfunction alone.
- Scenario 2: **Aortic repair and agitation**. The earlier claim that beta-blockade should be avoided because heart rate is not the main driver is withdrawn. No replacement antihypertensive regimen is prescribed.
- Scenario 3: **Chronic LVAD low-flow alarms**. A low-flow alarm does not justify empiric speed, fluid or transfusion changes outside specialist assessment.
- Scenario 4: **VV-ECMO with hypoxemia**. A normal post-membrane value does not prove that all circuit-related causes are absent or make transfusion/paralysis automatic.
- Scenario 5: **Explicitly chosen comfort-focused care**. Comfort-only goals are explicitly supplied here and are not inferred from DNR/DNI. Sedative combinations are not automatically appropriate; choices require proportionate symptom-focused assessment by the treating team.

## 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.