17-year-old boy with wrist fracture. This patient became blue during manipulation of the fracture under bier’s block anaesthetic effect.
Arterial blood gas was performed and it showed the following:
PH = 7.30
PCO2 = 28 mmHg
PaO2 = 83 mmHg
HCO3 = 18 mmol/L
COHb = 1.2 %
MetHb = 47 %
Na = 136 mmol/L
K = 4.1 mmol/L
Cl = 102 mmol/L
Lactate = 3.2 mmol/L
Cr = 52 nmol/L
BSL = 5.6 mmol/L
Questions:
- Interpret these blood gases
- Why did this patient turn blue and what is the mechanism behind that?
- What other potential complications you need to consider (Prepare for) when you perform Bier’s block?