17th July 2020

An 80-year-old man is being brought into the emergency department by the ambulance crew

An 80-year-old man is being brought into the emergency department by the ambulance crew. He is complaining of an excruciating abdominal pain which came on suddenly this morning. He has never had this type of pain before and complained that the pain is constant. He has vomited twice so far. He has an extensive history of cardiac diseases. On examination, he has a diffuse abdominal pain with guarding. His temperature is 38.9 ºC, pulse rate 110 bpm, respiratory rate 30/min and oxygen saturation of 94%. 3-lead ECG shows an irregularly irregular pulse. You also did an ABG and the results are shown below:

• pH: 7.29 (7.35 – 7.45)
• pO₂: 10.3 (10 – 14)
• pCO₂: 2.5 (4.5 – 6.0)
• HCO₃: 15 (22 – 28)
• Lactate: 8 (<2)

What is the best initial management for this patient?

Which THREE of the following are correct? Select THREE options only.