A patient with COPD for more than 20 years was admitted to the hospital with complaints of cough with gray sputum, shortness of breath with minimal physical activity, fever up to 39C. A week ago, he was discharged from the hospital, underwent treatment for an exacerbation of COPD with recommendations for taking bronchodilators, inhaled corticosteroids in a satisfactory condition (when FEV1 was discharged, 60% Tiffno 0.7, moderate shortness of breath, cough mostly in the morning hours much less frequently). This exacerbation is associated with hypothermia. On examination, the condition is serious, takes a forced position, presses his right side with his hand. The shape of the chest is barrel-shaped, the right half lags behind in the act of breathing. RR 35 in 1 min, pronounced cyanosis of the lips, mucous membranes, hot skin, blush on the cheeks, more on the right. With percussion on the right below the angle of the scapula, the sound is dull, the voice tremor on the right in the lower sections is sharply increased. Heart sounds are accelerated, rhythmic with a heart rate of 106 per 1 min, blood pressure 160/100 mm Hg. Temperature 39.6C. The task. Formulate a preliminary diagnosis. Describe the expected picture on auscultation of the lungs. Appoint additional examination, treatment.
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