Case Study (2) for Advanced Medical (Paramedics)
For the following scenario please provide in point form:??1. Presence or absence of acidaemia/hypoxia, ?2. Types of alkalosis/acidosis if any present?3. Most likely diagnosis?4. Treatment strategies employed to stabilise patient for transport to a tertiery facility Initial Information: (Used paramedics Guidelines to cover this scenario )
?An 18 year old man who is an insulin dependent diabetic is admitted to the accident and??emergency department. He has had been vomiting for 48 hours and because he was unable to eat, he chose to omit his insulin.
• He is in a sinus tachycardia at a rate of 130 min
• Blood pressure is 90/65 mmHg.
• He is breathing spontaneously with deep breaths at a rate of 35 min and is receiving oxygen 4 L/min via a Hudson mask.
• His GCS is 12.
. ?Arterial blood gas analysis reveals:?
• FiO2 0.3 (30%) estimated ?
• pH 6.79 (7.35 – 7.45)
• PaCO2 11.3 mmHg (35 – 45 mmHg)
• PaO2 129.2 mmHg (>75 mmHg) when breathing air
• HCO3 4.7 mmol/L (22 – 26 mmol/L)
• BE 29.2 mmol/L ( +/- 2 mmol/L)
• The blood glucose is 30 mmol/L and there are ketones+++ in the urine
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