Clinical introduction

A 73-year-old man with a history of smoking, alcohol abuse, hypertension and diabetes was brought to the Emergency Department after a sudden loss of consciousness. Blood pressure was 80/60 mm Hg, heart rate was 100/min, respiratory rate was 30/min, pulse oximetry was 80% on ambient air and temperature was 36°C. On physical examination, he was unresponsive, his skin was mottled, no signs of trauma were evident, respiratory sounds were reduced on the left hemithorax and pulses were symmetrical. The ECG showed sinus tachycardia with diffuse ST segment depression. A portable chest X-ray (CXR) was performed …