SAQ 819 – Metabolic – altered mental state with severe VBG abnormalities

A 44-year-old man is transferred to your ED from supported accommodation after a fall with altered conscious state. His history includes schizophrenia, alcohol misuse, anxiety/depression, insomnia and COPD. His regular medications are escitalopram, risperidone, diazepam and temazepam. Examination shows a small abrasion over the right temporal region.

List six (6) differential diagnoses for this patient's altered conscious state.

(Marked out of 6.0)

Observation	Value
SpO2	94% on 6 L O2 via Hudson mask
HR	115 bpm
BP	140/90 mmHg
GCS	13 (E3, V4, M6)
Temperature	37 C

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A VBG is performed as shown. List four (4) abnormalities on the VBG and provide two (2) interpretation points in the context of this presentation.

(Marked out of 6.0)

Parameter	Result	Reference range
pH	7.23	7.35-7.45
pCO2	70 mmHg	35-45 mmHg
HCO3	23 mmol/L	22-26 mmol/L
Na+	100 mmol/L	135-145 mmol/L
K+	3.7 mmol/L	3.5-4.5 mmol/L
Cl-	67 mmol/L	98-106 mmol/L
Ionised Ca2+	1.00 mmol/L	1.05-1.3 mmol/L
Lactate	2.5 mmol/L	<2 mmol/L
Hb	29 g/L	120-160 g/L
Glucose	10 mmol/L	3.9-5.5 mmol/L

</p> <table class="saq-prop-table"> <thead> <tr> <th>Section</th> <th>Finding</th> </tr> </thead> <tbody> <tr> <td>Abnormality 1</td> <td></td> </tr> <tr> <td>Abnormality 2</td> <td></td> </tr> <tr> <td>Abnormality 3</td> <td></td> </tr> <tr> <td>Abnormality 4</td> <td></td> </tr> <tr> <td>Interpretation 1</td> <td></td> </tr> <tr> <td>Interpretation 2</td> <td></td> </tr> </tbody> </table> <p>

/ 6

Complete the table by listing three (3) immediate management priorities and giving a detail for each.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Management priority</th> <th>Detail</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

Total Score: 0 / 18

Percentage: 0%