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A 35 year old white man previously fit and well presented to the emergency department late one evening, with an episode of haemoptysis. He developed sudden left chest pain and breathlessness while having a drink in a local pub. The history obtained by the ambulance crew was that he coughed up half a litre of blood in the pub toilet.
On initial examination he was conscious but visibly distressed. He was noted to be tachypneic (respiratory rate 28 breath/min) and in severe pain over his chest and back. His initial pulse rate was 112 beat/min and his blood pressure was141/93.The well healed scar of a thoracotomy was noted over the left side of his chest.
His partner who was present explained it was for the repair of a “hole in the heart” 23 years ago, when he was aged 12. He had been on follow …
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