Deteriorating and Desaturating

Authors: Abigail Ward / Editor: Steve Corry-Bass / Codes:  / Published: 12/09/2019

A 74-year-old man presents to the Emergency Department (ED) with sudden onset shortness of breath that started two hours ago. He initially appeared well, but when you see him he is struggling to talk and appears pale and distressed. He has associated left sided chest pain, which has been getting worse. He said it feels like he can breathe, but no matter how big a breath he takes it is not enough. He was sitting when the shortness of breath started.

He is a non-smoker and has never had any respiratory problems before. He has a history of diverticular disease, GORD and OA. He had a hip replacement three weeks ago and is recovering well. He has mild pain and leg swelling but was told to expect this following the surgery and it is not causing him significant impairment.

When you examine him you find he has cold extremities, is tachycardic and is very short of breath. He has reduced air entry in the mid left zone, but no extra sounds, percussion is normal. Heart sounds are normal, but you note he is tachycardic. His obs show HR of 119, RR of 28, Sats of 87% on 5L – which is dropping, BP 133/87 and temp of 37.4oCelsius. He is moved to a resus bay.

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