1st April 2022

A 66-year-old man presents to the emergency department with severe abdominal pain

A 66-year-old man presents to the emergency department with severe abdominal pain. He reports that the pain came on suddenly 2 hours ago and has been there constantly despite morphine given by the ambulance crew. He has vomited once and mentions that he never had this type of pain before. He has a past medical history of Type 2 diabetes mellitus, atrial fibrillation and hypertension. He smokes 30 cigarettes per day.

His observations on admission are:

• Temperature: 38.6 ºC
• Respiratory rate: 25/min
• Pulse: 116 bpm
• BP: 110/78 mmHg
• SpO₂: 95%

An ABG has been done and shows the following:

• pH: 7.23 (7.35 – 7.45)
• pO₂: 11.1 (10 – 14)
• pCO₂: 3.6 (4.5 – 6.0)
• HCO₃: 17 (22 – 28)
• Lactate: 5.2 (<2)

What is the best initial treatment for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.