Posted by Dan Crompton
This 72 year old man presented by ambulance, to a regional hospital at 4am, acutely short of breath. He complained of having had a cough and increasing dyspnoea for the last 3 days but suddenly worse at 2am. He had recently been diagnosed with COPD after a hospital admission for pneumonia and the paramedics had given him a total of 15mg salbutamol and 1.5mg ipratropium. His initial sats were 77% and he had widespread wheeze but no crackles. He hadn't improved much on the way.
PMH
COPD
- recently diagnosed following similar presentation
HT
recent ex-smoker
abdominal surgery - uncertain what
DH
Salbutamol
Tiotropium
Atorvastatin
Bromhexine (bisolvon)
First set of Obs in ED
P 123 BP 160/110 RR 35 SaO2 86% GCS 15 Temp 36.5
This is his ECG.
PMH
COPD
- recently diagnosed following similar presentation
HT
recent ex-smoker
abdominal surgery - uncertain what
DH
Salbutamol
Tiotropium
Atorvastatin
Bromhexine (bisolvon)
First set of Obs in ED
P 123 BP 160/110 RR 35 SaO2 86% GCS 15 Temp 36.5
This is his ECG.
What are the major abnormalities on this ECG?
What additional assessment would you perform?
What additional assessment would you perform?