Author: Hannah Lee Chadwick, Andrew Charlton / Editor: Nick Tilbury / Codes: PhC2, RP8, SLO3 / Published: 15/09/2022
A 34-year-old male is brought to the Emergency Department (ED) after a fire at his home. He was pulled out of the building by the fire service.
He has a GCS of 3 on arrival to ED and is hypotensive despite an initial fluid bolus.
He is intubated on arrival and is ventilated with an FiO2 of 1.0 – peripheral saturations are 99%.
There is no evidence of external burns on the patient. He is normally fit and well with no regular medications.
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Question 1 of 3
1. Question
Given the above presentation what is the most appropriate first investigation?
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Question 2 of 3
2. Question
An ABG is performed. This shows the following:
- pH 7.1
- pO2 15 kPa
- pCO2 5 kPa
- BE -9
- HbCO 5%
- Lactate 15 mmol/L
It also shows a raised anion gap.
What is the most likely cause of the patient’s presentation?
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Question 3 of 3
3. Question
Given the likely cause of this patient’s presentation what is the most appropriate initial management?
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6 responses
interesting case
interesting case
Nice case
great case
nice case. at first I focused on CO poisoning, until I noticed that the level wasn’t very high. I eventually dragged cyanide from the recesses of my mind. hopefully it will stay nearer the front of my mind now!
really Interesting case.