Author: Isabel Mansilla, Umer Hakeem, Ragul Ragupathy / Editor: Sarah Edwards / Codes: CP2, EnvC7, RP1, RP5, SLO1, SLO2, SLO3 / Published: 17/03/2025
A 45-year-old man presents with a one-week history of shortness of breath, right-sided chest pain, and malaise. He describes the chest pain as sharp, pleuritic, and initially intermittent, now worsening with minimal exertion. He recently discontinued anticoagulation a month ago following treatment for a suspected provoked pulmonary embolism (PE) after major upper limb surgery. His history also includes haemochromatosis requiring regular venesections, and he began overnight CPAP therapy for suspected sleep apnoea within the past week.
On arrival to the Emergency Department (ED), his vital signs include a pulse of 90 bpm, blood pressure of 136/70 mmHg, temperature of 36.6°C, respiratory rate of 28 bpm, and GCS of 15.
Examination reveals cyanosis with oxygen saturations at 88% on room air, improving to only 92% on 15 litres of oxygen. His cyanosis persists despite oxygen therapy. Lung auscultation reveals clear breath sounds without crackles or wheeze. Due to low sPO2 despite oxygen administration, re-assessment was required including social history.
He states that he hasn’t taken any recreational drugs or alcohol, however, he reports that he works with vehicles and has been painting cars and using a dye spray with a ceramic coating compound for the last two weeks without wearing a face mask.
