75 year old male is BIBA after taking an odd turn. According to his wife he became acutely confused with the inability to talk and unable to walk.
She reports that his behaviour was very similar to previous preictal states and therefore she gave him 10mg Diazepam. The wife reports he has been a bit “off” since being started on pain medication.
The patient has a background of epilepsy on phenytoin, AVR on Warfarin, HTx. He has recently had a fall and was prescribed tramadol and oxynorm for rib pain.
O/E the patient is drowsy with a GCS 13.
ABG on FiO2 0.4:
pH 7.09 Na 135 mmol/l
PCO2 83mmHg K 4.7mmol/l
PO2 91mmHG Cl 97 mmol/l
HCO3 26 mmol/l Lactate 1
B/E -8
- Describe and interpret the ABG
- List the top 4 investigations you would do to further assess this patient and why