A 75 year old male presents to ED after 2 syncopal episode at home.

He has a background history of IHD, hypertension and TIA’s. He is on dual antiplatelet therapy and 2 antihypertensive medications. O/E BP 100/70 HR105 Sats 96% RA Apyrexial RR 22. ECG normal sinus rhythm with left axis deviation, normal intervals and no ST segment changes.

VBG:

pH 7.20                                              Na 136 mmol/l  

pCO2 22mmHG                                K 5.1 mmol/l

HCO3 9mmol/l                                 Cl 101 mmol/l                  

B/E -17                                               Cr 185 umol/l

BSL 3.1mmol/l                                  Hb 73mmol/l

Lactate 18mmol/l

1. Describe and interpret the VBG

2. Define syncope and discuss an approach to the assessment of a patient with syncope