Acutely short of breath at 2am - raised troponin but no chest pain......

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.

What are the major abnormalities on this ECG?
What additional assessment would you perform?