Heavy Breathing

Author: Maria Angela Garcia / Editor: Nick Tilbury / Codes: CC4, CP2, RP5, SLO1, SLO2 / Published: 28/06/2022

A 30-year-old male with no significant past medical history presents to the Emergency Department (ED) with shortness of breath and a dry cough for the past two weeks.

The patient explains that his symptoms have increased in severity in the last 4 days and that they are particularly bad on exertion. He reports that the symptoms coincide with his family cleaning up the attic which is next to his bedroom. He is a non-smoker and has no relevant family history. A COVID antigen test is negative.

On examination you note a BMI >35 and on auscultation you hear widespread coarse crackles bilaterally. He has a fast but regular heartbeat with no murmurs and there is mild pitting oedema in the legs.

Observations:

• SpO2 95% on room air
• HR 129
• BP 185/157
• RR 28
• T 36.9°C

His initial ABG:

• PH 7.44
• PO2 7.60
• PCO2 4.66
• HCO3 23.4
• Lac 1.12

His blood results:

• WBC 8.1
• Neu 5.6
• D-Dimer 1149
• CRP 3.51
• Urea 5.2
• Creatinine 99
• Troponin 30

A CXR is performed as shown below.