A 52-year-old man presents to AMEU after collapsing at home. He is pale on appearance with cold extremities. The following are his parameters on admission.
HR> 100/min,
RR>24/min
PaCo2 < 32mmHg (ref 38 to 42 mm Hg or 5.1 to 5.6 kPa)
Lactate levels > 4 mmol/l
Urine output <0.5 ml/hour
BP< 90 (> 20mins)
a) Based on the above, what criteria of a clinical condition has the patient met?
b) In your targeted history, what important information would you like to obtain to arrive at the possible causes of the above scenario. List 5.
c) The patient was found with an infected ulcer on the sole of her left foot. What is the expected cardiac index and pulmonary wedge pressure? Explain why not exceeding 4 sentences.
Answers
Answer:
A 52-year-old man presents to your office for an acute visit because of
coughing and shortness of breath. He is well known to you because of
multiple office visits in the past few years for similar reasons. He has a
chronic “smoker’s cough,” but reports that in the past 2 days his cough
has increased, his sputum has changed from white to green in color, and
he has had to increase the frequency with which he uses his albuterol
inhaler. He denies having a fever, chest pain, peripheral edema, or other
symptoms. His medical history is significant for hypertension, peripheral
vascular disease, and two hospitalizations for pneumonia in the past
5 years. He has a 60-pack-year history of smoking and continues to
smoke two packs of cigarettes a day. On examination, he is in moderate
respiratory distress. His temperature is 98.4°F, his blood pressure is
152/95 mm Hg, his pulse is 98 beats/min, his respiratory rate is 24
breaths/min, and he has an oxygen saturation of 94% on room air. His
lung examination is significant for diffuse expiratory wheezing and a
prolonged expiratory phase of respiration. There are no signs of cyanosis.
The remainder of his examination is normal. A chest x-ray done in your
office shows an increased anteroposterior (AP) diameter and flattened
diaphragms, but otherwise he has clear lung fields.