State the presence or absence of acidaemia Custom Essay

Question 75
. ? For the following scenario please answer in point form:??1. State the presence or absence of acidaemia, ?2. State the types of alkalosis/acidosis present?3. State the most likely diagnosis?4.

Outline treatment strategies employed to stabilise patient for transport to a tertiary facility.???Initial Information??

. A 75 year old man is on the surgical ward 2 days after a laparotomy for a perforated sigmoid??colon secondary to diverticular disease. He has become hypotensive over the last 6 hours.??His vital

signs are:
• Heart rate 120/min – sinus tachycardia – warm peripheries
• Blood pressure 70/40 mmHg
• Respiratory rate 35 breaths/min
• SpO2 on oxygen 92%
• Urine output 50 mL in the last 6 hours
• GCS 13 (E3, M6, V4)
.
. Arterial blood gas analysis reveals: (Normal values in brackets)?
• FiO2 0.4 (40%) approx
• pH 7.12 (7.35 – 7.45)
• PaCO2 34 mmHg (35 – 45 mmHg)
• PaO2 62 mmHg (75 mmHg) when breathing air
• HCO3- 12 mmol/L (22 – 26 mmol/L)
• BE – 15 mmol/L (+/- 2 mmol/L)

10 points

Question 76
. ? 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??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

10 points