MRCP2-0572

MRCP2-0572

A 55-year-old man was brought to the Emergency department after being found collapsed at home. His wife reported that he had been experiencing back pain and was taking two different types of pain medication. He also had a history of breathing difficulties and used an inhaler as needed.

Upon examination, the patient had a Glasgow coma scale of 7/15 and his pupils were small and equal, but slowly reactive bilaterally. Reflexes were brisk throughout with bilateral up-going plantars. His heart rate was 100 beats per minute regular, blood pressure was 100 mmHg systolic and 80 mmHg diastolic, and his respiratory rate was only six breaths per minute.

Arterial blood gases on 15 L of oxygen showed the following results: pH 7.20 (7.36-7.44), PaO2 35.3 kPa (11.3-12.6), PaCO2 9.0 kPa (4.7-6.0), and Bicarbonate 18 mmol/L (20-28).

What would be the next course of treatment, aside from addressing basic airway, breathing, and circulation concerns?