Author: Toby Shipway /Â Editor: Jason M Kendall / Reviewer: Jolene Rosario, Ciaran Mackle / Codes: ACCS LO 2, ResC7, RP5, SLO3 /Â Published: 10/08/2020 / Reviewed: 21/09/2024
A 62-year-old lady presents with a 10-hour history of increasing shortness of breath and sharp, right-sided chest pain.
She had a previous pneumonia over a year ago requiring hospitalisation but is otherwise fit and well. She moved from Turkey to the UK 4 months previously.
Initial observations are as follows: SaO2 89% on 15L inspired oxygen, RR 32, BP 83/45, HR 106, temp 37.9, GCS 15.
Auscultation of the chest reveals decreased air entry and course inspiratory crepitations over right middle and upper zones of the lung and widespread wheeze.
Arterial blood gas analysis (on 15L inspired O2) is as follows: pH 7.32, pO2 7.2, pCO2 6.7, BE -5, HCO3 18.
U&E’s are as follows: Na 132, K 3.6, Urea 8.4, Creat 99.
Her CXR is shown.
Fig.1 Courtesy of the author
Module Content
Breathlessness
Dyspnoea is an overall term used to describe an unpleasant awareness of increased respiratory effort and will be used synonymously with "breathlessness" in this session.
Chest Pain Syndromes
Chest pain is caused by a spectrum of pathology ranging from the innocent to the extremely serious.
Cardiogenic Pulmonary Oedema
Patients who present with CPO have a poor long term outcome but their short term mortality can be improved by early correct management.
9 Comments
Unfortunately no question to answer
All fixed now, sorry about that
Common and important case
Good point about raised pco2 due to tiring but not requiring NIV. Also low bicarbonate suggests metabolic acidosis . Good case for revision of common conditions in Ed
Good case. Interestingly the BHIVA/BASHH/BIA Adult HIV Testing guidelines 2020 would avocate HIV testing for community acquired pneumonia or invasive pneumococcal disease, particularly pneumonia recurrent within a year. https://www.bhiva.org/file/5f68c0dd7aefb/HIV-testing-guidelines-2020.pdf
good case
THANKS
Good learning case
good example of a fairly common presentation.