Today, I ran an elderly pt with moderate SOB, SaO2 at 92%. My pt had a huge list of medical issues that included every respiratory problem known to man. Lung sounds slightly diminished but no rales or wheezing. No edema visible on extremities. I give the pt a neb treatment and then upon reassessment, I hear the lung sounds get worse with rales. As it turns out, the pt was on lasix even though I didn't see it in her house and it was working according to the doc at the hospital. Plus, there was slight JVD that I didn't notice. The doctor told me when I gave albuterol, it opened up the pts bronchioles and increased the pulmonary edema. As it turns out, there was pitting edema. Even though there was nothing visible on the pts ankles, the doctor showed me there was in fact pitting edema visible on the mid shinbone. Anyway, I thought this was a neat call and wanted to get some opinions about it as well as share it with you all.
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