Author: Yasmin Sultan / Editor: Lou Mitchell / Codes: RP7, SLO3, SLO6 / Published: 21/04/2021

A 65-year-old man attends the ED complaining of a 2-day history of worsening shortness of breath.

He has ulcerative colitis and has recently been admitted for one week with a flare. His azathiaprine was discontinued due to him developing renal impairment, and he was discharged 5 days ago on a reducing dose of prednisolone. His bowel symptoms have remained well controlled. Over the last 2 days he has noticed increasing shortness of breath on exertion, most severe today. He has no other comorbidities and is taking no other medications.

On examination he is pale, clammy and short of breath at rest (respiratory rate 24 breaths per minute). His oxygen saturation on air is 93%. His heart rate is 140 beats per minute and his blood pressure 88/60.

His Haemoglobin is 96 (on a venous gas sample). His 12 lead ECG shows a sinus tachycardia with no ischaemic changes.
A bedside ultrasound scan is performed to investigate his shock state.