Author: Bilal Sayyed, Mohamed Gresha, Varshini Maddali / Editor: Sarah Edwards / Codes: CC3, CP3, NepC2, NepC3, NepP1, SLO3 / Published: 20/02/2025
A 59-year-old man presents to the Emergency Department (ED) by ambulance with complaints of dizziness and palpitations. The ambulance crew has pre-alerted the PCI team due to a symptomatic complete heart block the patient received 600 mcg of atropine enroute. The cardiac team has advised transport to the ED resuscitation bay, with instructions to start an isoprenaline infusion if the patient becomes symptomatic.
Past Medical History:
- Type 2 diabetes mellitus
- Ischaemic heart disease
- Chronic kidney disease (Stage 3) (CKD)
- Hypertension
On Initial Assessment:
- Airway: Patent, patient is coherent, well oriented
- Breathing: Clear chest, Respiratory Rate (RR) 14 breaths/min, SpO₂ 100% on room air
- Circulation: Warm peripheries, heart rate (HR) 35/min (range 30-40), blood pressure (BP) 121/58 mmHg, heart sounds S1 and S2 normal, capillary refill time <3 seconds
- Disability: GCS 15, pupils equal and reactive, moving all four limbs
- Exposure: Afebrile, temperature 37°C; soft and non-tender abdomen, no pedal oedema
- NEWS Score: 1
- BP on the previous visit was 194/93 and 164/87
Current Medications:
- Bisoprolol 2.5 mg daily
- Aspirin 75 mg daily
- Dapagliflozin 10 mg daily
Allergies:
- Naproxen and codeine
Venous Blood Gas (VBG) Results:
- pH: 7.34
- pO₂: 6.1 kPa
- pCO₂: 6.3 kPa
- K⁺: 5.9 mmol/L
- Na⁺: 140 mmol/L
- HCO₃⁻: 24 mmol/L
- Lactate: 2.7 mmol/L
- Glucose: 12.5 mmol/L
