11th January 2024

A 47-year-old homeless man presents to A&E with fever and shortness of breath, which became progressively worse over the last week.

A 47-year-old homeless man presents to A&E with fever and shortness of breath, which became progressively worse over the last week. His blood pressure is 104/85, HR 102, saturations 94% on 2L of oxygen, RR 20 and temperature 37.8. He has no medical records and can’t think of any past medical history himself, although he has not seen a doctor since childhood. He tells you he has ‘always’ been slightly short of breath. Lately, he has been feeling very sweaty and hot at night, but he attributed it to the hot weather. He smokes cigarettes and crack cocaine, drinks alcohol occasionally, and has never been outside of the UK. On auscultation, he has fine crackles throughout the lungs, heart sounds are normal, and there is mild pitting oedema of the ankles/ Chest x-ray is shown below. He has sinus tachycardia on ECG, and bloods show moderately high inflammation markers, troponin of 19, and d-dimer of 400. Given most likely cause of his presentation, what would the best management plan be for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.