Respiratory AKT questions

A 46-year-old gentleman was involved in a road traffic accident where his car hit a wall. He was extricated at the scene and has been brought in by ambulance. He has cervical immobilisation in situ. He is complaining of chest pain on the left side of his chest and is breathless. You are the trauma call team leader. His observations are as follows: HR 110, BP 102/63, SaO₂ 90% on air. GCS 15/15. On examination, he has extensive bruising on the left side of his chest and he has reduced chest expansion, dullness to percussion and reduced breath sounds throughout the entire left hemithorax.

A 27-year-old man presents with a one-week history of a dry cough that has now started to produce a little sputum. He is also complaining of myalgia, tiredness, headaches and has had diarrhoea for the past 2 days. His observations are as follows: temperature 38.9^oC, HR 91, BP 128/75, RR 22, SaO₂ 98% on air. On examination, he has audible crackles on the right side of his chest. His chest X-ray shows right upper lobe consolidation.

A 48-year-old businessman returns from a trip to Los Angeles with shortness of breath and pleuritic chest pain. The results of his arterial blood gas (ABG) on-air are shown below:

• pH: 7.48
• pO₂: 7.4 kPa
• PCO₂: 3.1 kPa
• HCO₃-: 24.5 mmol/l

A 40-year-old man presents with a dry cough and a fever for the past few days. His cough is non-productive. Today he has also had several episodes of diarrhoea and has developed bilateral pleuritic chest pain. He states that he is short of breath, most notably on exertion. He works as a Jacuzzi and whirlpool installer and smokes 15 cigarettes per day.