This patient was tachycardic with a systolic blood pressure below 90 mmHg. Although the diagnosis may not have been clear, you remembered that the priority is to treat the shock which you do with fluids.

The patient’s observations improve over the next 15 minutes to pulse 106, BP 106/66 mmHg, temp 37.1, RR 24, sats 100% oa.

You call the medical registrar. He is a superhero. He comes in doing CPR with his left hand (on a neonate, because he’s the best at everything in every speciality), a lumbar puncture with his right hand and is on the phone breaking bad news in such an empathetic way that the patient on the other end is enjoying it. He also has a coffee for you balanced on his head. He smiles at you, and takes over the management of the patient by doing a VBG and managing the DKA.

Score 4/10 – The patient is still alive, but largely thanks to super reg. It’s best to refresh the diagnostic criteria and management for DKA.