Author: Toby Shipway / Editor: Jason M Kendall / Reviewer: Jolene Rosario / Codes: ACCS LO 2, ResC7, RP2, RP5, SLO2Published: 10/08/2020

A 62-year-old lady presents with a 10-hour history of increasing shortness of breath and sharp, right-sided chest pain.

She has had a previous pneumonia requiring hospitalisation but is otherwise fit and well. She moved from Turkey to the UK 4 months previously.

Initial observations are as follows: SaO2 89% on 15L inspired oxygen, RR 32, BP 83/45, HR 106, temp 37.9, GCS 15.

Auscultation of the chest reveals decreased air entry and course inspiratory crepitations over right middle and upper zones of the lung and widespread wheeze.

Arterial blood gas analysis (on 15L inspired O2) is as follows: pH 7.32, pO2 7.2, pCO2 6.7, BE -5, HCO3 18.

U&E’s are as follows: Na 132, K 3.6, Urea 8.4, Creat 99.

Her CXR is shown.

RUL consolidation