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Term 7 Week 10 (w/c 9/12/13)

December 9, 2013

Good Morning and welcome to this weeks #gasclass.

You are the on call anaesthetist covering the critical care unit at a small District General Hospital. You have been asked to attend the Emergency Department where a 42 year old man has been brought in by ambulance having been found unconscious at home.

As you walk to the Emergency Department What are your initial thoughts?

You arrive in the Emergency Department and find that the man remains unconscious. The paramedics tell you that he was found at home surrounded by various tablets and bottles, none of which have any labels on them. On examination he is unresponsive to pain, hypotonic and hyporeflexic. His pupils are dilated and react only slowly to light.

What are your thoughts now? What are your next steps?

Whilst assessing the patient his breathing becomes laboured, following which he suffered recurrent  grand mal convulsions. His biochemistry reveals: Na 163  K 4.8 Ur 5.7 Cr 290  ABG pH 7.06  pCO2 1.52 pO2 19.6 HCO3 3

What are your thoughts now? What is your plan? 

You have decided to intubate and then take to CT on the way to ICU.  How are you going to do this?

CT is unremarkable, and the man is transferred to the ICU. Over the course of the next 12 hours he becomes cardiovascularly unstable, develops pulmonary oedema and is anuric.

Repeat bloods reveal Na 165 K 5.2 Ur 7.9 Cr 350 Ca 1.4  Anion Gap 60

Whats are your thoughts? What do you do now?

Some interesting suggestions last night, paracetamol is undetectable. You locate his old notes and discover that he has previously been admitted with overdose of antifreeze.  Could this be the case now?

If we assume that the man has taken a significant volume of antifreeze how do we treat him? 

There are no trick questions in #Gasclass. Everyone’s contribution is welcome. Please do not forget to add the ‘hashtag’ #gasclass to every Tweet so that it is included in the conversation. To help give new contributors an opportunity to join in we would advise that you should only add one idea per tweet and not contribute until another Tweeter has joined in.

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