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On arrival to the emergency department he has: a patent airway RR 16, SaO2 99% on 6L oxygen, and right mid zone crackles on auscultation of the lungs HR of 106/min, BP of 123/76, with warm peripheries GCS is 8 (E2V2M4) Venous blood gas on arrival shows a pH of 7.29, PCO2 of 46, HCO3 of 23 and a lactate of 5.3

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