A 75 year old with chest trauma after a motor vehicle collision

1. Acute respiratory acidosis

No compensation – reflects acute insult

Elevated A-a gradient (A-a gradient = 40, assuming FiO2 of 0.3) due to VQ mismatch or shunt

mild hypokalaemia – reflects some depletion, however ?significance in trauma

mild hyperglycaemia – stress response

mild increase in lactate – ??blood loss, hypothermia, other

2. Causes:

Chest trauma – rib fractures with pain, haemopneumothorax, pulmonary contusion

Other – opiate therapy for pain with hypoventilation, COPD exacerbation

3. Primary survey, address immediate life threats

Treat pain, provide oxygen as required

Treat cause

Appropriate disposition to trauma unit/ surgical ward