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