Case presentation
A 63-year-old, undomiciled male, who has been out of care for many years presents with shortness of breath for the last 3 days. He has also had 3 days of constant, substernal chest tightness which is not pleuritic, positional or exertional. He has a chronic cough with some worsening yellow sputum production but no fevers. He denies leg swelling. He is an active smoker with a 40 pack-year history. He has a history of alcohol abuse and methamphetamine abuse. His EKG does not show any acute ischaemia.
Initial vital signs
BP 135/96, pulse 121, RR 28, temperature 36.3, oxygen saturation 95% on room air.
The patient is tachypnoeic. His heart sounds are notable for tachycardia without murmurs, gallop or rubs. His lung sounds are notable for both wheeze and rales at the bases. His abdomen is soft and non-distended and non-tender, and his extremities are warm and well perfused without...
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