It is now 30 minutes since Josh arrived. The team has arrived.

After 40ml/Kg fluids you reassess the situation.

A- patent
B - RR 50, sats unrecordable
C - P160, BP unrecordable, cap ref 5 secs
D - Unresponsive.
E - BM 5 Rash is now florid and confluent in areas.

You obtain IV access and take a gas (arterial)

pH 6.9
pCO2 4.5
pO2 16.9
BXS -20
HCO3 5
Lactate 15

Your anaesthetists gets ready to intubate and you decide to start an infusion of noradrenaline.