A patient recovering from a laparotomy was referred to ICU from recovery. She is a 72 year old lady with a background of CCF, who underwent a laparotomy and adhesiolysis in the context of a subacute small bowel obstruction.

Following the laparotomy, this lady was extubated and brought to recovery. There, the breathing was found to be shallow and rapid. The pulse oximeter trace was unreliable as the patient was very cool and clammy peripherally. There was a sustained failure to awaken; the lady became increasingly unresponsive, and central cyanosis developed. The anaesthetist decided to perform a blood gas. While waiting for the result (the machine was performing a two-point calibration) a rapid sequence induction and intubation were performed.