Pulmonary Medicine Blog By Dr Deepu
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A 20-year-old woman comes to the ED
with a 2-week history of gradually progressive shortness of breath, orthopnea,
and dysphagia. She reports an 18-lb (8 kg) weight loss and subjective fevers
over the same period of time. She also describes chest tightness and a
nonproductive cough. The patient was empirically treated by her private
physician with a course of antibiotics without improvement 7 days ago. She was
told that there was an abnormality on her chest radiograph and a chest CT scan
was performed, but she did not follow up on the results. She is a never-smoker
and has no history of asthma. On physical examination, the patient is in
mild-to-moderate respiratory distress with a respiratory rate of 32/min; BP,
152/84 mm Hg; and pulse rate of 130/min. Her temperature is 38.4° C. Neck
examination reveals jugular venous distention. On lung examination, there is
diff use wheezing. Her current posterior-anterior and lateral chest radiographs
are shown (Figs 1-A, 1-B). A chest CT scan is ordered, but the patient becomes
more short of breath (accentuated when supine in preparation for the CT scan),
restless, and confused. Her respiratory rate increases to 40/min, and her
oxygen saturation is 88% when breathing 50% oxygen by face mask.
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The next step in this patient’s
management should be:
A. Awake intubation in the
semiupright position.
B. Rapid sequence intubation.
C. Noninvasive mechanical ventilation.
D. Emergency tracheostomy.
B. Rapid sequence intubation.
C. Noninvasive mechanical ventilation.
D. Emergency tracheostomy.
also comment on the CT and Chest X Ray
Please come back on Tuesday for answer.
Please come back on Tuesday for answer.
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