42 year old alcoholic man, with type 2 DM. Presented with alcohol withdrawal symptoms. His blood gas (VBG) showed the following:
PH = 7.599
PCO2 = 22 mmHg
42 year old alcoholic man, with type 2 DM. Presented with alcohol withdrawal symptoms. His blood gas (VBG) showed the following:
PH = 7.599
PCO2 = 22 mmHg
Answers:
PH = 7.24 that is moderate acidaemia.
HCO3 = 16 mmol/L, so we have metabolic acidosis.
Next, we need to calculate the anion gap and the compensation.
The chest x-ray shows Continue reading
The abdominal x-ray shows Continue reading
The chest x-ray shows Continue reading
The following chest x-ray is from an adult with chest pain. What can be seen? Continue reading
54-year-old asthmatic patient presented with multiple episodes of vomiting. Her pulse-rate was 110 and blood pressure was 96/54. Her blood gases showed the following:
PH = 7.24
pCO2 = 33 mmHg
Question 1:
PH = 7.32 ( less than 7.35) so, we have mild acidaemia.
PCO2 = 48 mmHg ( on arterial blood gas > 40), so we have respiratory acidosis.
Next step, is to calculate the metabolic compensation. Since the condition is acute, we expect the HCO3 to increase by 1 for every 10 PCO2 above 40. Accordingly, expected HCO3 is 24.8. That is very close to 24. So there is no additional metabolic process.
Other findings
Mild lactataemia which can be attributed to dehydration or salbutamol therapy. K = 3.4 (can be also related to salbutamol therapy).
Question 2:
Respiratory acidosis in asthma is a critical situation (severe/ life threatening asthma – even if the acidosis is mild).
This patient should be moved to a resuscitation bay, we should inform the emergency consultant and ICU team. Request the help of anaesthetic team for fast rapid intubation.
Start treatment immediately. (Hit it hard and hit it fast), our aim is to prevent intubating this patient.
Treatment:
Non-invasive ventilation in severe asthma help to:
Ultimately, NIV in asthmatic patient help in the correction of PH and improves ventilation at a lower pressure than that needed for mechanical ventilation and it reduced the need for intubation.
BiPAP setting:
If the above measures fail then we need to proceed to intubate this patient. For intubation, we use Ketamine as the sedating agent and the intubation should be performed by the most experienced doctor available.
The abdominal x-ray is from an adult with severe epigastric pain. Erect chest x-ray shows no air under the diaphragm. Potential cause of abdominal pain? Continue reading
32-year-old man presented to ED with an exacerbation of his asthma. On 3L O2, his arterial blood gases showed the following:
PH = 7.32
PO2 = 101 mmHg