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Scenario two – introduction

You are working in the Emergency Department (ED) when a colleague asks you to assist with a 60-year-old man who has been admitted after suffering an out-of-hospital cardiac arrest.

The paramedics report that they arrived within seven minutes during which CPR had not been attempted. His initial rhythm was VF and a spontaneous circulation was restored after the third shock.

When you arrive, the patient has been intubated and ventilated with 50% oxygen. His heart rate is 120 min-1 and his BP is 150/95mmHg. He is comatosed with a GCS score of 3.

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Graphical text that says: Intubated, Ventilated 50% oxygen, Heart rate – 120 min[sup]-1[/sup], BP 150/95mmHg, Comatose GCS 3.
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See chapter 15 of the ALS manual for further reading about arterial blood gas analysis.

5-step approach to ABG interpretation

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Step 1 – how is the patient?

Step 2 – is the patient hypoxaemic?

Step 3 – is the patient acidaemic or alkalaemic?

Step 4 – what happened to the PaCO2?

Step 5 – what has happened to the base excess or bicarbonate?

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