Chest and Abdominal Radiographs Case 2

You are the senior doctor on duty one evening when the nurses call you into resus to see a 61 year old man, brought in by ambulance, with acute difficulty in breathing.

You find him sitting upright with a mask delivering 24% oxygen.

He is pale and his skin is sweaty. He is alert but too breathless to talk, answering questions by nodding/shaking his head. He communicates that he has no pain and his breathing has got worse over the past few hours. He has no cough or sputum. He has not been diagnosed as having any chronic chest disease.

What actions would you take with this 61 year old patient?

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He has a sinus tachycardia of 128 on the monitor and his BP is 186/96. His SaO2 is 94% on 15L O2. His respiratory rate is 24 and temperature is 36.2o.

IV access is obtained in his right antecubital fossa and blood sent for routine testing.

The ECG shows sinus tachycardia with some ST depression in the lateral leads.

Looking at the chest x-ray on the right, describe the abnormalities and state your diagnosis.

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You are considering specific treatments for this patient.

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