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LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

Scenario

A 22 year-old man who was using intravenous amphetamines has been brought to the ED by police. He is handcuffed and in an agitated state. Vital signs: HR 140 bpm, BP 200/110 mmHg, RR 22, temperature 38.10C, SpO2 98% on room air. GCS 14- confusedInitial investigations include an arterial blood gas on room air:

pH 7.25 mmHg (7.35-7.45)
pCO2 23 mmHg (35-45)
pO2 99 mmHg (75-100)
HCO3- 10 mmol/l (22.0-33.0)
Lactate 5 mmol/l (0.7-2.5)
Glucose 10 mmol/l (3.0-7.8)
Base Excess -16 mmol/l (-3-+3)

Question 1

Describe and interpret the arterial blood gases.

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SCE 2013 2 001 question 1

Question 2

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Outline your approach to this patient’s agitation.

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SCE 2013 2 001 question 2

Question 3

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The patient is now sedated. His serum CK is 80,000 IU/L. He develops a broad complex bradycardia with a HR of 30bpm. His BP is 70 systolic.Describe your management.

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SCE 2013 2 001 question 3

Question 4

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During the restraint, a security guard sustained a needlestick injury. Describe the management of the security guard.

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SCE 2013 2 001 question 4

ACEM Fellowship Structured Clinical Examination Questions

 

FACEM SCE 2013 2 001
Neil Long

Article source here:Life in the Fast Lane

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