ABSTRACT
Examination This man appears unwell with shallow respiratory effort. He has reduced chest wall expansion bilaterally. On auscultation there is reduced air entry bilaterally and inspiratory crackles. The jugular venous pulse (JVP) is not elevated and heart sounds are normal. His pulse is thready and rapid and he has cool hands and feet. Abdominal examination is normal. His score on the Glasgow Coma Scale is 14/15 (opens eyes in response to voice, orientated, obeying commands). A chest X-ray is obtained (Fig. 58.1). An ECG reveals sinus tachycardia. Observations: temperature 38.5°C, heart rate 105/min, blood pressure 85/51 mmHg, respiratory rate 28/min, SaO2 89 per cent on room air.
