Author: Gavin Lloyd / Editor: Steve Fordham / Reviewer: Louise Burrows / Codes: A2Published: 05/11/2019

At the 8am departmental handover, you discuss a 69-year-old man with COPD who presented two hours earlier with SOB. He reports increasing cough productive of white sputum for the last four days and worsening SOB for two days. He was discharged yesterday from ED with a five day course of prednisolone and home inhalers for a diagnosis of non-infective exacerbation of COPD. His PMHx also includes arteriopathy and NIDDM.

In the night, he experienced further deterioration and called 999. He denies fever. His observations improved from 84% oxygen saturation on air, RR 28 to 100% on high flow oxygen and RR 20 following 2 x 5 mg salbutamol nebulisers from the paramedic crew.

He has a widespread wheeze on clinical examination. You are shown: WBC 8, CRP < 3 and an ECG demonstrating sinus rhythm rate 80 and an ischaemic heart disease pattern identical to previous records. Your ED colleague wonders whether his chest x-ray demonstrates a left-sided pneumothorax.

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