Case 5

An 85 y/o man presents to ED complaining of a 4 hour history of severe, 10/10, generalised abdominal pain with associated vomiting. He has a history of ischaemic heart disease and atrial fibrillation (AF). He is in rapid AF at 135bpm, BP is 160/90, Sats of 96% on room air, RR is 28 and he is apyrexic.

His VBG demonstrates a metabolic acidosis with a high lactate and a low pH.

Question 1

What is the most likey diagnosis?

Question 2

What investigations would you organise for this patient?

Question 3

What is the ED management and ultimate disposition for this patient?