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.

Revised 27 October 2026. This summary follows the corrected case bank. 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.