On examination he looked well, he was breathing normally, there was no increased work of breathing and he was talking in full sentences. However, the examination equipment revealed that his pulse was consistently above 130bpm. This was confirmed on both the pulse oximeter (which also showed saturations of 95%) and the sphygmomanometer (which also showed blood pressure of 124/74). The patient was very calm and relaxed, so it was unlikely that anxiety was causing this tachycardia.
Despite the patient looking so well and not being concerned, his heart rate caused me significant concern. I explained this and his partner called an ambulance whilst I waited. He was referred to A&E as likely respiratory sepsis. When the patient arrived in A&E, a 12 lead-ECG identified atrial fibrillation. Blood tests revealed electrolyte disturbances and he was also diagnosed with a lower respiratory tract infection. He was admitted and treated for all of the above as an inpatient. On discharge, he was feeling fit and well again.
Following discharge, the patient received follow up care from the cardiology team, and was referred to the community COPD team and has a rescue pack to enable prompt treatment of lower respiratory tract infections.