A 79-Year-Old Man With Dyspnea and a Cold Shock (original) (raw)

A 79-year-old man was brought to the ED with progressive dyspnea, dizziness, tachycardia, and arterial hypotension, which developed over the last 48 h. Personal medical history revealed past smoking. On presentation, his vital signs were a respiratory rate of 36 breaths/min, heart rate of 130 beats/min, arterial pressure of 90/60 mm Hg, oxygen saturation of 98% breathing oxygen at a flow of 4 L/min, and axillary temperature of 36 C. Physical examination showed a severely distressed patient, with dyspnea, effortful tachypnea, cold and pale skin and mucous membranes, and skin mottling over the thighs and knees. He did not manifest chest or abdominal pain. Cardiac auscultation showed rapid and regular heartbeats, with no audible S3, S4, or murmurs. Peripheral pulses were filiform. Lung auscultation was normal. The abdomen was nontender. Surface ECG showed sinus tachycardia, a 1-mm ST elevation in aVR, and a 1-mm ST depression from V2 to V5. Laboratory data showed a blood hemoglobin level of 8.5 g/dL, a WBC count of 17,000 cells/mL