The anaesthetist comes running, airway devices in one hand and crosswords in the other.

“What’s happened?”

“He’s breathing fast.”

“He’s got an airway though, hasn’t he? And he’s not in extremis and his sats are 100% on air…and my word, is that Kussmaul breathing? What’s the cause? What did the blood gas show?”

“I…wanted you do the blood gas when you were here to get…the…most up to date…result…”

The disappointment is deafening. Even the patient next door knew the anaesthetist wasn’t needed, and he’s unconscious.

For the sake of patient safety, the anaesthetist sedates you and sees the rest of the medical patients that evening.

Score: 5/10 You called the anaesthetist, gave fluids early and no one died. It wasn’t unsafe care, but it wasn’t very efficient and we still don’t have the diagnosis of DKA formally confirmed. It may be worth reviewing the guidelines.