Feeling Short of Breath
A 35-year-old male patient presents to the Emergency Department (ED) with a one-week history of shortness of breath and a cough. His blood pressure and heart rate are normal.
Despite appearing comfortable, his oxygen saturation on room air is 69%. He has a history of pulmonary hypertension secondary to congenital hypoventilation syndrome.
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Question 1 of 3
1. Question
A chest radiograph is obtained (Fig. 1).
Fig.1 Image courtesy of the author
Based on the x-ray and information provided, what is the most likely diagnosis?
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Question 2 of 3
2. Question
You decide to perform a bedside echocardiogram to assess for a pericardial effusion. Which of the following is the best view for assessing the pericardium in the Emergency Department (ED)?
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Question 3 of 3
3. Question
The bedside echo reveals a large pericardial effusion as shown (Fig. 2).
Fig. 2 Large pericardial effusion
His blood tests show a raised C-Reactive Protein (CRP) and white cell count.
His Vital signs are as follows:
- Oxygen saturation: 95% on supplemental oxygen
- Respiratory rate: 20 breaths per minute
- Blood pressure: 134/76 mmHg
- Heart rate: 90 beats per minute
- Glasgow Coma Scale 15/15
- Temperature 37.8 degrees Celsius
Which of the following is the most appropriate next treatment step?
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