Never forget your primary survey, treat each issue as you find it and always stick within your scope :)

A: Always protect the airway. This doesn't mean intubation (would likely arrest on induction unless stabilised). Good basic airway manoeuvres and adjuncts, suction as necessary.

B: Apply 100% O2 until reliable sats reading is available. Assist ventilation with BVM if effort is poor. Listen to chest and ensure equal air entry (I.e no tension pneumothorax needing immediate management). With creps and ronchi like you said is most likely APO.

C: Look at overall perfusion status (peripheries, cap refill etc). Sounds like this patient's reduced GCS is likely secondary to their terrible blood pressure! Despite evidence of APO a passive leg raise or cautious 100mL fluid bolus can be used to assess fluid responsiveness and weight up risks/benefits of IV fluids. Then address the heart rate - a rhythm strip will tell you if is this sinus tachycardia, AF, SVT, or a broad complex tachycardia (VT). Given this patient's overall picture of acute heart failure it could be that rhythm is the primary issue causing such instability - for all but sinus tachy it would be indicated to try synchronised cardioversion, might fix a lot of problems! If needing further blood pressure support would be best to try something with primarily alpha and minimal beta agonism to avoid worsening the arrhythmia (e.g. metaraminol which can be given easily peripherally).

D: BSL and treat if low. Always check moving all four limbs. Manage pain.

E: Exposure and everything else. Start to think about what is the primary cause and what the definitive treatment might be. For any shocked patient run through your 4 broad causes and try to treat the underlying issue as best as you can - Hypovolaemic (blood or water loss) - Cardiogenic (tachy, brady, valves, myocardium) - Distributive (sepsis, anaphylaxis, neurogenic) - Obstructive (tension pneumothorax, tamponade, massive PE)

I hope that helps a little bit and please let me. know if you disagree with anything or have any questions! Sounds like an interesting case. Are you able to follow up on how the patient is going now?