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It is another rainy day at the office. Ambulances are queuing outside when Matron pulls you out of the coffee room to see a ‘patient with shortness of breath’ in the resuscitation room. There is a smell of alcohol as you walk in.
The patient is mumbling incoherently and has the following;
List at least five actions for your immediate management of the patient.
What are the causes of DKA?
The foundation year one doctor offers to do the ABG for you, if you will sign his DOPS form. The ABG is as follows:
pH 6.95
pCO2 2.5 kPa
pO2 42.1 kPa
Na 140mmol/L
K 3.3mmol/L
Hb 12 g/dL
Glucose 44mmol/L
Lactate 6mmol/L
BE –20.2,
Bicarbonate 6.2mmol/L.
The F1 doctor wishes to give sodium bicarbonate. What do you say?
The nurse has drawn an insulin infusion and wishes to start it now.
Do you want to start the insulin now? What are the reasons for your answer?