SAQ 472 – Toxicology – smoke inhalation with carbon monoxide and lactic acidosis

A 32-year-old male smoker is brought to a tertiary ED after a fire at his metal cleaning and reclaiming shop. He has a fluctuating conscious state but no airway compromise, burns or other major injury. His examination and venous blood gas are shown below.

Observation	Result
GCS	13 (E4 M5 V4)
Temperature	36.5 C
Respiratory rate	10/min
Blood pressure	88/55 mmHg
Heart rate	130/min
SpO2	96% on O2 6 L/min via face mask

Variable	Result	Reference range
pH	7.18	7.35-7.45
pO2	100 mmHg
pCO2	45 mmHg	40-52
HCO3	12 mmol/L	24-32
COHb	18%
Na	145 mmol/L	135-145
K	4.8 mmol/L	3.5-4.8
Cl	107 mmol/L	95-110
Glucose	10.8 mmol/L	3.0-6.0
Lactate	16 mmol/L	0.5-2.0

List three (3) important abnormalities and state the significance of each.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Abnormality</th> <th>Significance</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> </tbody> </table> <p>

/ 6

Provide two (2) calculations that assist diagnosis and state how each contributes.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Calculation</th> <th>Contribution to diagnosis</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> </tbody> </table> <p>

/ 4

List the two (2) most clinically important differential diagnoses.

(Marked out of 2.0)

/ 2

List two (2) specific treatments you would commence, including doses/routes where applicable.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Specific treatment</th> <th>Details</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> </tbody> </table> <p>

/ 4

Total Score: 0 / 16

Percentage: 0%