Blood Gas of the Week #25
A 2 year old, castrated male English Pointer mix is transferred to the ICU from the OR where he underwent exploratory laparotomy for a septic abdomen due to small bowel perforation associated with linear foreign body ingestion. The OR team rounded the ICU team that the patient had progressive hypotension during surgery which initially was responsive to crystalloid and colloid fluid boluses but became refractory by the end of the anesthesia. Total anesthesia time was just under two hours, and in the last 20 minutes of the procedure he was on less than 1% isoflurane and no injectable anesthetic agents were needed to maintain his anesthesia. He has been off gas anesthesia (isoflurane) for 47 minutes now, and his last doses of injectable anesthetic & analgesic medications were hydromorphone 0.1mg/kg & midazolam 0.3mg/kg premedication about 3.5 hours ago, ketamine 5mg/kg and propofol 1mg/kg induction about 3 hours ago. Broad-spectrum antibiotics were initiated at the time his septic abdomen was diagnosed. The dog is intubated, spontaneously ventilating, has no palpable pulse, and no response to noxious stimuli. The patient is instrumented for monitoring with an arterial catheter and direct blood pressure, end-tidal CO2, ECG, and pulse-oximetry. He is receiving oxygen on a Mapelson circuit at 3L/min as well as crystalloid at 6ml/kg/h and hydroxyethylstarch at 1ml/kg/h.
The following vitals and monitoring readings, as well as the blood gas were recorded immediately following the hand-off. Interpret the blood gas:
T 96.4F P 76 R 12 mm pale CRT prolonged BCS 5/9 Weight 42kg BP 42/31 (35mmHg) ETCO2 42 SpO2 100% PaO2 364 ECG: atrial standstill
Step 1: Evaluate the pH
Step 2: Determine the primary process
You recognize that this patient is critically compromised and arrest is imminent. What immediate interventions will you perform to prevent this from occurring? Check out the discussion here on Wednesday…
