October 9, 2013
The rescue team is called for respiratory distress in a 44-year-old woman, who is found agitated and tachycardic, with BP 100/65 mm Hg. She is brought to the ED with the diagnosis of panic attack.
In the ED she becomes more hypotensive (BP, 90/60 mm Hg), so she is shifted to an acute-care bed and given intravenous fluids. Arterial blood gas analysis shows compensated lactic acidosis and hypoxemia (pH 7.38; lactates, 7 mM; Paco2, 27 mm Hg; Pao2, 60 mm Hg). Further history reveals chronic anemia and hemorrhoids; digital rectal exploration shows purulent fluid. A surgical consultation is requested (it having been determined that there was no need for urgent surgery).