# Delicious Dyspena



## MrBrown (Apr 21, 2011)

Its dinner time and you are called to a local buffet restaurant for a lady complaining of severe dyspena/SOB

The patient is an elderly grandmother who is part of a group of vacationers who have recently flown into town.  She is moderately short of breath, has minor accessory muscle use and no cyanosis.

HR 140
BP 140/100
RR 32 regular
SPO2 94% RA
ECG Sinus tach
Temp 37.5
BGL 7 mmol (100 mg/dl approx)
Breath sounds absent on right
Patient complains of pleuritic type pain on right

PMHx of emphysema, diabetes and gout
Meds glucophage, salbutamol and diclofenac

What is wrong with Nana that is preventing her from eating dinner?


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## Aidey (Apr 21, 2011)

Beyond the breath sounds being absent, how do things sound over there? Is it dull or hyperresonant? 

What preceded the SOB? Was she eating? Acute or sudden onset? Any cough? Anything like this happen before?


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## mycrofft (Apr 21, 2011)

*How long has this been going on? (Time since onset)?*

Sudden onset, onset over minutes, hours, days? 

Medications aside, either she's blown a bleb and is going tension pneumo on us, she sucked down a partial upper dental bridge arguing over the Green Goddess dresing, or she's inhaled a box jelly.


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## NomadicMedic (Apr 21, 2011)

She just flew into town? 

PE is my guess.


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## MrBrown (Apr 21, 2011)

Aidey said:


> Beyond the breath sounds being absent, how do things sound over there? Is it dull or hyperresonant?
> 
> What preceded the SOB? Was she eating? Acute or sudden onset? Any cough? Anything like this happen before?



Sudden onset, no cough, was eating but its not aspiration, hyper-resonant

A debate was had whether as anybody ever percusses a chest, Brown said sure, no reason ambos can't do it 



mycrofft said:


> Sudden onset, onset over minutes, hours, days?



About 10 minutes



n7lxi said:


> She just flew into town?
> 
> PE is my guess.



Nope


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## Nerd13 (Apr 21, 2011)

I guessed PE but found out I was wrong as soon as I posted haha. Spontaneous pneumo? I guess I'll keep thinking...


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## NomadicMedic (Apr 21, 2011)

Ha. I knew a Brown scenario wouldn't be that easy.


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## mikie (Apr 21, 2011)

Fbao?


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## Aprz (Apr 21, 2011)

Her history of flying in made me think pulmonary embolus, but absent breath sound on the right, hyperresonance, right sided pleuritic pain (temp WNL suggests it's not pneumonia) would make me put right sided pneumothorax at the top of my list right now. Do we have equal rise and fall of the chest? Is the trachea midline? Is subcutaneous emphysema present?


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## CAOX3 (Apr 21, 2011)

She aspirated while eating, some COPD patients dont have the ability to deter inhaling when they swallow, they may swallow while inhaling and aspirate.


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## CAOX3 (Apr 22, 2011)

MrBrown said:


> Sudden onset, no cough, was eating *but its not aspiration*, hyper-resonant



Disregard I missed this. :lol:


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## mycrofft (Apr 22, 2011)

*Ummmmmmmmmm get the zebra gun*

A tumor has just grown to the point that, flapper-valve-like, it blocks COPD-weak exhalations past it's rt side location beside or in the bronchus, causing that lung to remain hyperinflated, pleuritic, and unventilated.

Really, the horse we hear is tension pneumo, right? Question would be etiology.


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## Aidey (Apr 22, 2011)

Actually, I think the hose is a simple pneumo, maybe borderline. Her vitals say "sick" but I don't think they are quite "massive amounts of pressure in her chest" sick.


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## firetender (Apr 22, 2011)

*Delicious Dyspena or Dyslexia?*



MrBrown said:


> Its dinner time and you are called to a local buffet restaurant for a lady complaining of severe dyspena/SOB



If you hadn't used the misspelled word twice I would have let it slide.


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## Gecko24 (Apr 22, 2011)

Meh, he did not give enough info.  Need more H&P.


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## SURFKT22 (Apr 24, 2011)

Does she have a history of being sick? What's her temp? Has she had an elevation change? Skin signs?


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## emtgirl515 (Apr 24, 2011)

SURFKT22 answers to most of your questions are in the first post.


Only saying because I just reread it. : )


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## Frozennoodle (Apr 27, 2011)

Spontaneous Pneumothorax.  Hyper-resonance and absent unilateral lung sounds combined with pleural pain?  Make this a tall, thin, male for text book-like presentation.  PE wouldn't have diminished lung sounds as an emboli wouldn't affect ventilation, FBAO would have a significantly shorter time of onset, 10 minutes onset fits with a pneumo.  Etiology is the pressure changes from the flight.


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## MrBrown (Apr 27, 2011)

Yup it was a spontaneous pneumo caused by changes in pressure during her flight


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## mycrofft (Apr 30, 2011)

*Barometric changes and a bleb.*

Had a young man incarcerated who's CXR revealed numerous blebs and pre-blebs. If he wasn't a violent felon we'd have had him paroled.


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## Chief Complaint (May 8, 2011)

MrBrown said:


> Yup it was a spontaneous pneumo caused by changes in pressure during her flight



What was your treatment for this patient?


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## MrBrown (May 8, 2011)

Chief Complaint said:


> What was your treatment for this patient?



Put patient on stretcher and drive to hospital, put patient in waiting room, go back to restaurant and finish her meal for her


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## Chief Complaint (May 8, 2011)

How kind of you!


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