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

Elevated lactate

Elevated glucose

2. Cardiogenic shock with poor peripheral perfusion.

Inadequate ventilation

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