Author: Benjamin Scally, Fraser Denny / Editor: Nick Tilbury / Codes: ACCS LO 2, CC3, CP3, PhP1, RP7, SLO3 / Published: 28/09/2023
A 69-year-old man is brought to the Emergency Department (ED) by ambulance. He looks unwell and states he feels dizzy.
Paramedics tell you he has a background of type 2 diabetes mellitus, ischaemic heart disease, and chronic kidney disease.
You perform a brief assessment:
A – Patent and unprotected
B – Chest clear, RR 18, Sp02 96% on air
C – Cool to touch, clammy, HR 28, BP 72/41, HS I+II+0
D – GCS 15, pupils equal and reactive, moving all 4 limbs
E – Apyrexic, abdomen soft non-tender, nil peripheral oedema
He is moved to resus and given IV atropine 1mg. His heart rate improves to 41 but his blood pressure remains unchanged.
He has a prescription list with him, which contains the following regular medications:
- Bisoprolol 10mg once daily
- Ramipril 10mg once daily
- Furosemide 40mg once daily
- Eplerenone 50mg once daily
- Metformin 500mg three times daily.
He has initial blood tests done including a venous blood gas:
- pH 7.27
- PO2 3.2
- PCO2 7.1
- K+ 6.8
- Na 130
- HCO3 24
- Lac 4.7
- Glu 11.2
