Middle aged man critically unwell, in acute pulmonary oedema and likely cardiogenic shock on a ventilator.
1. acute mixed metabolic and respiratory acidosis
high A-a gradient
2. Cardiogenic shock with poor peripheral perfusion.
Large VQ mismatch and shunt due to APO
Impaired glucose control/ undiagnosed diabetes
3. Change Ventilator settings:
-Increase RR or TV – however check airway pressures. High airway pressures can lead to barotrauma and pneumothorax which will only worsen the patients condition.
Check ECG (if not already done so) – urgent Cardiology consult for ECHO/ early PCI. Also Aspirin, Ticagrelor, Heparin infusion (also GTN infusion)
ICU consult for admission and ongoing management