A Blood Gas Brain Freeze

Author: David Leverton / Editor: Daniel Becker / Reviewer: Michael Perry, Ahmad Alabood / Codes: A4, CC1, PP2 / Published: 01/09/2022

You are asked to see a 51-year-old lady who has been taken to the resus room. The ambulance crew tell you she has taken an overdose 5 hours previously. She has informed the ambulance crew she drank a full 1 Litre bottle of “green liquid from the garage” and taken “some tablets” but cannot remember what they were. Her normal medications include sertraline and oxazepam. She has a past medical history of depression but is otherwise fit and well.

Her initial observations are as follows:

  • A: Self-maintained
  • B: RR: 20 sats: 99% on air
  • C: CRT< 2 secs centrally, BP: 185/66, HR: 84, well peripherally perfused
  • D: GCS 14/15 E4 M6 V4, PEARL 4+ bilaterally moving all 4 limbs normally but not compliant with full CNS or PNS testing
  • E: abdomen soft, non tender

Clinically the patient appears intoxicated. Nursing staff have obtained bilateral wide-bore IV access An ECG shows sinus tachycardia Bloods have been taken including a paracetamol/salicylate level The following venous blood gas has been obtained during cannulation.

David Leverton SAQ - A Blood Gas Brain Freeze Image

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