Sudden onset chest pain and respiratory distress
An 80 year old gentleman presented to the emergency department with sudden onset shortness of breath with right sided chest and back pain. He was housebound and using short burst oxygen therapy for severe lung fibrosis and was noted to have oxygen saturations of 91% on room air at his last clinic appointment. He stopped smoking 20 years before, but previously he had smoked 70 packs a year. He had been heavily exposed to asbestos for 22 years while working as an electrician in a factory that put carbon black into tyres. He was taking omeprazole, alendronate, aspirin, and long term prednisolone. There was no other medical or family history of note, and there had been no recent trauma.
On examination, he was very unwell and cyanosed, with SaO2 of 66% on 10 L oxygen. He had a respiratory rate of 44 breaths a minute, blood pressure of 140/89 mm