Station - Instructions for candidate
You are a final-year medical student on placement in the Emergency Department of an urban teaching hospital.
Enzo Caruso, a 22-year-old warehouse worker, was brought to the Emergency Department by ambulance with drowsiness and vomiting for 6 hours. The triage nurse has recorded his observations and taken a venous blood gas. You have been asked to interpret the results and begin immediate management.
| Triage observations | HR 112 regular, BP 105/68 mmHg, RR 28 (deep breathing), SpO2 96% on room air, temperature 37.1 degrees C |
|---|---|
| Handover from parents | Son has type 1 diabetes; ran out of insulin 3 days ago; progressive drowsiness and vomiting since this morning; fruity-smelling breath; no recent illness or trauma |
Results provided:
Venous blood gas
| Item | Value | Reference range |
|---|---|---|
| pH | 7.15 | 7.35-7.45 |
| pCO2 | 25 mmHg | 35-45 mmHg |
| pO2 | 95 mmHg | >80 mmHg |
| HCO3 | 9 mmol/L | 22-26 mmol/L |
| Lactate | 2.5 mmol/L | <2.5 mmol/L |
| Na | 130 mmol/L | 135-145 mmol/L |
| K | 5.2 mmol/L | 3.5-5.0 mmol/L |
| Glucose | 32.4 mmol/L | 3.5-5.5 mmol/L |
vbg abg - read aloud by the examiner
Severe metabolic acidosis with elevated glucose and altered K+ distribution.
Look up an example image: LITFL diabetic ketoacidosis
Your tasks are to:
- Interpret the venous blood gas and bedside findings provided.
- State your most likely diagnosis and one or two key differentials to the examiner.
- Outline your immediate management plan for the first hour, including IV access, fluid resuscitation, medications and monitoring.
- You do not need to take a history or perform a physical examination.
- Investigation results have been provided for interpretation.
- You do NOT need to summarise your findings to the examiner.
- The examiner will ask you questions at the end.
This is a 10-minute station, with 2 minutes of reading time.