This is the first of 3 weeks of posts. We’d love readers to play along and post up some answer suggestions on our facebook page (https://www.facebook.com/fellowshipexam).
A patient presents semiconscious after an unknown overdose. His medical history indicates a history of epilepsy, but there is no medical record of his medications listed. Initial bloods in resus are taken:
pCO2 26 mmHg
HCO3- 12 mmol/L
Na+ 140 mmol/L
Cl- 104 mmol/L
Creatinine 60 umol/L
Urea 4 mmol/L
BSL 5.5 mmol/L
Ketones Not detected.
Lactate 10 mmol/L
We’ve thrown this out in this week’s 5 point fellowship Friday to emphasise a couple of really important points about understanding the exam.
Work through the ABG and calculate the acid base disturbances.
Then ask yourself:
1.What are the possible diagnoses?
2.Are there any further bloods you need to check?
3.Are there any other bedside tests you’d run?
4.Is there a rare antidote you might have to give this patient?
*Every piece of information you have been given is fair game for your analysis.*
Share your thoughts on our facebook page at https://www.facebook.com/fellowshipexam.
If you want to read an ABG/VBG in 5 steps go to the RESUS Page
ShareThe Written Fellowship Course has its beginnings back in 2007, When Dr Kas started it at RPA in Sydney. It was then called the Kamikaze Course.