Beware the (Previously) Seriously Agitated Patient

"What do you think about this VBG from last night?" I asked, thrusting a ribbon of paper at my colleague.Initial VBGpH      <6.80pCO2    47 mm HgpO2        59 mm HgNa+       149 mmol/LK+           4.2 mmol/LCl-          99 mmol/LCa++     1.27 mmol/LGlu     211 mg/dLLac     >20.0 mmol/L​CO-OximetrytHb    16.3 g/dLsO2        69.2%"Was he dead?" he queried."Nope.""What was his anion gap?" came the next question."Fifty-one.""Ethylene glycol? Did you intubate him?" he asked.That was a great guess, but it was actually PCP and cocaine. The patient, out of control, was TASERed a few times. By the time he got to the ED, though, he was unresponsive, breathing like a freight train, and sweating so much he soaked the sheets. I didn't want to intubate him because he was doing a much better job blowing off his hydrogen ions than I ever could. I certainly didn't want to make that acidosis any worse. I was surprised his heart could keep beating in the environment he already had. I went with benzos, several liters of fluids, and followed the end-tidal CO2 (which was only 16 on arrival). The gap was down to 21 within 90 mi...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs