Found drowsy with pinpoint pupils

intro

A 33-year-old is found unresponsive on the ward two hours after a dose escalation of hydromorphone. Respiratory rate 6.

Blood gas

pH7.21

PaCO268 mmHg

HCO327 mmol/L

PaO266 mmHg

No high/low cues on purpose: read the numbers the way the gas machine prints them.

Stepwise interpretation

Commit to your own read first: pH, primary process, compensation, gap, delta, oxygenation. Then walk the engine’s steps and see where you agree.