ABSTRACT
Examination This man looks unwell and is cool to the touch. His jugular venous pulse (JVP) is not seen. There is no lymphadenopathy. His pulse volume is reduced and his capillary refilling time is 4 seconds. There is crepitus felt on the skin around the neck extending to the chest wall. His chest is dull to percussion on the right. Auscultation of the chest reveals air entry bilaterally with reduced breath sound and a pleural rub on the right side. His upper abdomen is very tender with absent bowel sounds. An ECG reveals sinus tachycardia. Observations: temperature 37.8°C, heart rate 130/min, blood pressure 90/60 mmHg, respiratory rate 28/min, SaO2 92 per cent on room air.
