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A higher inspired concentration of O2 should mean a higher PaO2. ■ With an inspired O2 concentration of 28%, a PaO2 of 21 kPa is expected, whereas with 100% O2, a PaO2 of 89 kPa would be expected (in theory). Therefore, if the patient has a PaO2 of 15 kPa but is receiving 60% oxygen, alarm bells should ring and further investigation into the perfusion status may be warranted. g. O2) may be required. Inspired O2 Expected PaO2 28% 21 kPa 40% 32 kPa 60% 51 kPa 100% 89 kPa 5 Base excess ■ Look at the base excess.

10 Other abnormalities ST-segment changes ■ Elevation: can be normal (‘high takeoff ’), acute MI, acute pericarditis (‘saddle’ shaped). ■ Depression: can be normal (upward sloping), digoxin (downward sloping), ischaemic (flat), posterior MI – changes in the posterior heart are seen as ‘reciprocal’ or ‘reflected’ changes (ST depression in leads V1–3). T-wave changes ■ Peaking: hyperkalaemia, acute MI. ■ Inversion: V1–3 can be inverted in children/Afro-Caribbean people (normal), post acute-phase of MI, myocardial ischaemia and left-ventricular hypertrophy (LVH).

G. syncope/dizziness, palpitations). There are three main types of recorders. g. 24 or 48 h. This is useful to detect diurnal heart rhythm changes but can be time-consuming to analyse. g. below 40 bpm and above 120 bpm) and are usually worn for 4–7 days. g. Memo or Reveal device): these are useful in patients who have infrequent symptoms. A small recording device is implanted in the subcutaneous tissue above the heart. g. syncope) is anticipated, by placing an activator over the device. The device stores a recording of the cardiac rhythm during and around the event, and can be left in place for a number of months.

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