Case 3

Archie, a 72-year-old man with known hypertension, a demand pacemaker and ischaemic heart disease, is brought by ambulance to the Emergency Department with dyspnoea that has worsened over 3 days. He appears clammy and unwell. He is able to speak the occasional word only but nods his head in response to direct questioning. He denies chest pain or fever.

His observations are as follows:

• Blood Pressure 160/95 mmHg
• Pulse 108 bpm
• Respiratory rate of 28
• Oxygen saturations 89% on room air
• Temperature 37.2°C

His ECG shows a sinus tachycardia and evidence of left ventricular hypertrophy but no acute ischaemic changes. His chest radiograph is shown above.

Which one of these actions is not correct?