A 73-year-old man presents by ambulance with three days of severe abdominal pain. He has ischaemic heart disease, non-insulin-dependent diabetes mellitus, hypercholesterolaemia, and early-onset dementia. He lives at home with his wife, who is his primary carer. She reports no symptoms other than abdominal pain.
His regular medications are metformin and coloxyl. His observations and ABG are shown below.
| Observation |
Result |
| BP |
80/40 mmHg |
| HR |
130 bpm |
| RR |
26 /min |
| O2 saturation |
93% on high-flow oxygen |
| GCS |
13 (E2 V3 M3) |
| pH |
6.95 (7.35-7.45) |
| pCO2 |
20 mmHg (35-45) |
| HCO3 |
8 mmol/L (22-26) |
| Base excess |
-25 (-1 to 1) |
| Lactate |
16 mmol/L (0-2) |
| Glucose |
12 mmol/L (3-6.5) |
| Na |
138 mmol/L (135-145) |
| K |
4.5 mmol/L (3.5-5.0) |
| Urea |
13.6 mmol/L |
| Creatinine |
0.15 mmol/L |
State three (3) calculations that would help you interpret these results.
(Marked out of 3.0)
/ 3
List four (4) pieces of information these results provide for this patient.
(Marked out of 4.0)
/ 4
Other than mesenteric ischaemia, list four (4) likely diagnostic causes of the lactate result.
(Marked out of 4.0)
/ 4
What is the value of CT scanning when investigating possible mesenteric ischaemia in this patient? State three (3) points.
(Marked out of 3.0)
/ 3
His wife declines further active treatment and requests palliation. State two (2) pieces of information that must be obtained before confirming this request.
(Marked out of 2.0)
/ 2
Other than analgesics and antiemetics, list two (2) medications that may assist symptom control.
(Marked out of 2.0)
/ 2
Total Score: 0 / 18
Percentage: 0%
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