Hey, welcome back clinical problem solvers. Thanks for joining us for another installment

of our space learning series in which we revisit schemas previously discussed on the podcast.

It's Steph Lay, and this is the first SLS episode that I'm doing since graduating internal

medicine residency.

Woo! Yeah, thanks. Today I'm here with my fellow co-host, Dan and Jack. So how are you guys doing, fellas? Doing awesome, Steph. And Jack, Jack, how are you doing? I'm doing good. I'm doing good. It's good to be back on Zoom. It's good to see you both. It's been a while. So, yeah, I'm excited to talk through a great case today. And I just want to put it out there for the listeners. To this date, I've never seen Jack not wear a sweater with a popped collar. He looks impeccable, even like in his pajamas, which I think is just a fancy sweater, you know? We can let the record show that my collar is not actually popped right now.

It is folded correctly. You can just see it through the top of the sweater. But my collar is not popped. I am not from a 90s boy band. That's not the bio that I'm bringing into this story. I know. I think you're very memeable. Very memeable. True story, true story.

All right.

Well, with that in mind, this is just a quick reminder, everybody, that this podcast is not

meant to be used for medical advice.

Just go to old-fashioned education.

All patient information has been modified to protect the identity of the patients who

are a part of these cases.

And the views expressed in our podcast do not necessarily reflect the opinions of our employers. Well, team, I know that these SLS episodes are designed to cover multiple schemas, and with that in mind, I found a doozy of a case from when I was on ICU last month. It's kind of, you know, the Occam's Razor versus Hickham's Dickham. This is kind of the opposite of Occam's Razor. There's just so much going on. So anyway, Dan, can you, sorry, I have to get an interjection in here. Can you tell us what Hickham's Dictum is? I'm not sure if it's, we can say that on the podcast, can we? The patient can have as many diagnoses as they want.

Okay, I heard a more colorful version, I guess, in my training.

Okay, so with that, in the spirit of how this case unfolded,

I'll just start off with the page that I received as the ICU admitting resident.

So this is, quote, new ICU admission, severe acidosis, intubated, pH, less than 6.8, PCO2, 28, with

serum bicarb, less than five. So what do you guys all make of this numbers? I can tell you that

my collar is now popped after hearing that ABG, because that will definitely get your adrenaline

going. But before we dive into the specifics of

this ABG, let's back up and go to a 30,000 foot view and start with a general framework for how

to approach acid-based disorders. For anyone who wants a deeper dive into this topic, I highly

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