daedalus
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*I am setting up this case scenario from a real case study. Diagnose the patient, I do not care about treatment. We all know he would get oxygen and transport. *
You are dispatched to a residence for a 48 year old white male for severe shortness of breath and some chest pain. You find him in a chair, his daughter had called 911 after the patient initially refused to let her, telling you that he is still waiting for his doctor to call him back.
You find the patient above in obvious distress, he his however able to speak to you. He tells you that he has never felt this way before and denies any history of pulmonary disease, smoking, cancer, heart failure, or trauma.
HPI: The SOB started yesterday, noticed only on exertion, however is now present at rest. Pt was not laying down when it started, but noticed it yesterday while walking around. Change in position can very slightly and temporarily improve his condition. He feels as though he cannot get enough air no matter what he does. The chest pain started an hour ago and is mild.
He has no known allergies. He does take ASA, a beta blocker, lipitor, metformin, and glipizide all daily.
Medical history includes hyperlipidemia, HTN, NIDDM, obesity, and MI. The patient with a nervous look on his face tells you he was discharged from the hospital two days ago following a heart attack. The MI occured 10 days ago. No surgical history.
Physical exam:
Vital signs- BP 150/90, pulse is 110 and irregular at the wrist, and regular respirations at 30/min. Patient is AOx4 and appears anxious.
HEENT: head unremarkable, no venous distention in the neck and a midline trachea.
Chest: Chest is atraumatic, and rises and falls equally with breathing. Rales are heard at the bases of lungs bilaterally. You hear a systolic murmur when listening to the heart.
Extremities: Skin is slightly cool but otherwise unremarkable. All peripheral pulses are present equal. No edema is found. Skin turgor is normal.
EKG shows atrial fibrillation and evidence of a recent inferolateral wall MI. Pulse oximetry shows 94% on room air.
Care to through out some ideas?
You are dispatched to a residence for a 48 year old white male for severe shortness of breath and some chest pain. You find him in a chair, his daughter had called 911 after the patient initially refused to let her, telling you that he is still waiting for his doctor to call him back.
You find the patient above in obvious distress, he his however able to speak to you. He tells you that he has never felt this way before and denies any history of pulmonary disease, smoking, cancer, heart failure, or trauma.
HPI: The SOB started yesterday, noticed only on exertion, however is now present at rest. Pt was not laying down when it started, but noticed it yesterday while walking around. Change in position can very slightly and temporarily improve his condition. He feels as though he cannot get enough air no matter what he does. The chest pain started an hour ago and is mild.
He has no known allergies. He does take ASA, a beta blocker, lipitor, metformin, and glipizide all daily.
Medical history includes hyperlipidemia, HTN, NIDDM, obesity, and MI. The patient with a nervous look on his face tells you he was discharged from the hospital two days ago following a heart attack. The MI occured 10 days ago. No surgical history.
Physical exam:
Vital signs- BP 150/90, pulse is 110 and irregular at the wrist, and regular respirations at 30/min. Patient is AOx4 and appears anxious.
HEENT: head unremarkable, no venous distention in the neck and a midline trachea.
Chest: Chest is atraumatic, and rises and falls equally with breathing. Rales are heard at the bases of lungs bilaterally. You hear a systolic murmur when listening to the heart.
Extremities: Skin is slightly cool but otherwise unremarkable. All peripheral pulses are present equal. No edema is found. Skin turgor is normal.
EKG shows atrial fibrillation and evidence of a recent inferolateral wall MI. Pulse oximetry shows 94% on room air.
Care to through out some ideas?
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