Author: Jessie Lynch / Editor: Sarah Edwards / Codes: PhC2, PhC3, PhC4, PhP3, SLO3 / Published: 15/07/2022

A 62-year-old farmer is brought to your Emergency Department (ED) by ambulance. His only medical history is hypertension, for which he takes ramipril 10mg OD.

He was working on the farm, sheep dipping, and was found collapsed by his wife when she became concerned that he had not returned back for dinner. When found, he had been doubly incontinent.

Paramedics have remarked that his respiratory effort seemed to become weaker en route, and they had to suction secretions a number of times.

He has a GCS of 11/15 (E3V3M5) with no signs of head trauma. He has a respiratory rate of 12, SpO2 of 80% on room air, profuse secretions, and coarse crackles throughout both lungs on auscultation. He is bradycardic, with a heart rate of 38bpm.

A VBG reveals:

  • pH 7.15
  • pCO2 7.7
  • pO2 4.5
  • HCO3- 16.1
  • Lactate 4.2
  • BE -8

ECG reveals a sinus bradycardia with diffuse T wave inversion and a prolonged QTc.

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