Author: Rabia Mustasim, Raja Azhar Iqbal / Editor: Nick Tilbury / Codes: GP10, GP9, RC1, SLO1, SLO2, SLO3 / Published: 22/08/2024
A 78-year-old previously healthy female presents to the emergency department (ED) with acute-onset chest discomfort and difficulty swallowing, following an episode of choking on a chicken bone during lunch. The patient’s spouse performed the Heimlich manoeuvre, which successfully dislodged the bone, but she has subsequently developed persistent and sharp chest pain that is worse on movement and deep inspiration and is sweaty and finding it difficult to swallow.
You note the patient’s face appears puffy and on palpation of her neck you find a sensation akin to walking on snow. The uvula appears to be centrally positioned, and there is no evidence of tongue enlargement.
Auscultation of the patient’s chest reveals bilateral equal chest rise and bilateral basal crackles. No urticarial rash is noted.
Her observations on arrival are as follows:
- Sats 89% on room air
- RR. 16 breaths / min
- BP 100/70
- HR 110/min
- Temp 38.6
A 12-lead ECG is normal.
