Q. What abnormalities are there on the gas result?

A. There is a metabolic acidosis with a raised lactate. There are a number of different explanations for this but in this scenario hypovolaemic shock is the most likely explanation.

Q. What would you do next?

A. This man had an urgent echo in the resus room to look for any cardiac injury and the went for a CT of chest and abdomen.

Results

Echo – normal

CT chest/abdomen – There is soft tissue injury / stab wound just lateral to the lower end of the sternum/xiphisternum. The wound is mainly limited to the subcutaneous tissue and does not appear to extend to the intercostal muscles. No pneumothorax/pneumomediastinum/free fluid in mediastinum. No lung parenchyma lesions. No free fluid in upper abdomen. No significant intra-abdominal injury.

After reading the report you decide to explore the wound which is indeed superficial and you close it with non-absorbable sutures.

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More questions!

Q.But how do you explain the lactic acidosis?

Q. Is there anything else to worry about in this case?