Author: Sarah Heikal / Editor: Gavin Lloyd / Reviewer: Triona Considine, Ahmad Alabood / Codes: A4, PP2 / Published: 12/06/2023
A 45-year-old man is brought to Emergency Department (ED) after his neighbours call an ambulance, concerned that he looks ‘unwell’. The paramedic crew bring him to resus since he appears cyanotic with sats of 82% despite high flow 02. His only past medical history is schizophrenia, for which he receives regular depot injections of antipsychotic medication.
The patient complains of a generalised headache, fatigue and anxiety. He admits to having taken a new ‘legal high’ several times in the past 48 hours.
His first observations in the ED are as follows:
HR 110, BP 98/54, RR 14, sats 82% on 15lO2 , T36.4. You note his work of breathing is surprisingly normal and agree with the crew that his chest sounds clear. You also note normal heart sounds.
His chest x ray is unremarkable. His ABG results on 15l O2 are:
- pH 7.30
- pCO2 3.7
- pO2 35.6
- HCO3 11
- BE -12.9
- SaO2 98%
