John Craig

A 70-year-old man presents to the emergency department with 2 days of rapidly worsening breathlessness, now present at rest, with orthopnea that feels like drowning. Take a focused history, perform a relevant examination, order urgent investigations, and initiate management.

1. 1Take a focused history of the acute breathlessness using SOCRATES
2. 2Screen for and exclude acute coronary, pulmonary embolic and infective causes
3. 3Explore comorbidities, medication compliance, and the alcohol precipitant
4. 4Verbalise a focused cardiorespiratory examination including a primary survey
5. 5Order and justify urgent investigations
6. 6State a working diagnosis with relevant differentials and severity
7. 7Initiate acute management and arrange referral, review and safety-netting