Breathlessness Case 1

A 78-year-old man presents to the ED with acute respiratory distress. On initial assessment, you think that he may have acute pulmonary oedema.

Which of the following historical factors would make the diagnosis of pulmonary oedema more likely?

Further history reveals that he is known to have ischaemic heart disease and has had previous similar episodes. Choose from the following list of examination findings those that are typically associated with pulmonary oedema:

His airway is not at risk, and supplemental oxygen is applied; his pulse oximetry rises from 88% on air to 93% on 15 litres of oxygen administered via a reservoir mask.

His arterial blood gas analysis on supplemental oxygen is as follows:
pH = 7.35
pO2 = 11 kPa
pCO2 = 5.0 kPa
HCO3- = 23 mmol/l
Base excess = -2
Lactate = 2.7 mmol/l

This is consistent with a presentation of acute pulmonary oedema: True or False?

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Look at the patient’s CXR and list four abnormal features: