This paper discusses the case of Mr. Ali (pseudonym) a 55-year-old man who was admitted to the…

Case Study:
This paper discusses the case of Mr. Ali (pseudonym) a 55-year-old man who was admitted to the orthopedic ward 2 days ago after falling eight steps from a ladder whilst cleaning gutters at home. He sustained 6 right sided rib fractures, a large abrasion in the chest wall and some underlying pulmonary contusion. Mr. Ali also sustained an inferior/superior pubic rami fracture on right. He is now on patient-controlled analgesia (PCA) for the management of pain. His medical history include hypertension, Type 2 Diabetes Mellitus, gastro-esophageal reflux disease (GERD), chronic obstructive pulmonary disease (COPD), and ischemic heart disease for which he had 3 coronary artery bypass gra.helper-self-disclosure/.helper-self-disclosure/ft in 2011. He is a current smoker. Mr. Ali has been taking medications, including pantoprazole 40 mg daily, clopidogrel 75 mg daily, salbutamol PRN, spiriva 18 mcg daily, and simvastatin 80 mg daily. During the night Mr. Ali experienced intermittent chest pain, persistent cough, difficulty breathing, and fever (temperature 38.3oC). Electrocardiogram (ECG) showed sinus tachycardia. Investigations included a chest x-ray, which showed worsening consolidation in the right middle/lower lobes, and a sputum sample. On examination, Mr. Ali is pale with cold peripheries. His clinical assessments revealed heart rate of 118 beats per minute, respiratory rate of 24 breath per minute, blood pressure of 170/85 mmHg, GCS 15/15, PEARL 3+, Temp 38.3, and SPO2 90% on 2L of oxygen via nasal prongs. While talking to Mr. Ali his clinical condition deteriorates. He reports severe right sided chest pain and back pain with increasing difficulty breathing. His RR is now 30 breaths per minute and shallow. He can only speak in short sentences. The SPO2 is now 87%. Routine blood and arterial blood gases were taken, and results show: K 4.8 mmol/L, Na 140 mmol/L, creatinine 148 µmol/L, glucose 10 mmol/L, WBC 15.3 x 109gL, Hb 10.5 g/L, INR 1.2, APTT 37 sec. ABG results reveal pH 7.30, PCO2 58 mmHg, PO2 55 mmHg, HCO3 20 mmol, BE -3, SaO2 88%. Mr. Ali is receiving supplemental oxygen and his SPO2 improves to 93%, but he is agitated.