Doctor rotation clinical scenarios

A 60-year-old man comes to the emergency department complaining of severe epigastric abdominal pain that radiates to his back. Clinical Scenarios

The pain improves when he leans forwards or assumes the fetal position. It is worse when he breathes in deeply. He also complains of nausea, vomiting, and loss of appetite. He smokes ten cigarettes and drinks 14 units of alcohol per day on average. On examination, he has tachycardia, tachypnoea, and low blood pressure. He is also confused. There are decreased breath sounds over the base of his left lung.

What tests would you request?

What management would you recommend?

What is the most likely diagnosis?

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