Author: Tim Osborne / Editor: Sarah Edwards / Codes: CC1, CC2, CP1, CP2, RP7, SLO1, SLO2, SLO3 / Published: 15/11/2021

An 84-year-old man presents to the Emergency Department at midday with severe chest pain and breathlessness and is moved immediately to the resuscitation room.

The pain has started around 8 hours earlier and gradually worsened. He feels dizzy and has nearly collapsed at home. For the previous month he has been getting short of breath on minimal exertion. There is no history of leg swelling or orthopnoea.

He has a past medical history of hypertension for which he takes ramipril. There is no other relevant medical or surgical history.

On examination he is distressed and in pain. He looks extremely unwell. His peripheries are cool and mottled. You cannot palpate a radial pulse. You cannot visualise the JVP. Heart sounds are quiet but you do not hear any murmurs. His respiratory rate is elevated and there are bi-basal crepitations. There is no limb swelling or pitting oedema.

Initial observations:

  • Temp 37.4
  • HR 98
  • BP 68/43
  • RR 28
  • O2 not reading reliably
Initial ECG7

Shortly afterwards the patient goes into a PEA cardiac arrest.

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