Critical Care
The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
July 2021 Critical Care Case of the Month: When a Chronic Disease Becomes Acute
Division of Pulmonary Sciences & Critical Care Medicine
University of Colorado
Denver, CO USA
History of Present Illness
A 32-year-old woman with no known past medical history presented with progressive shortness of breath for the past 2 weeks. She denied having a cough, fever, or chills, but she did have a one-month history of fatigue, weakness, and painful rashes on her hands.
PMH, SH, and FH
- No known past medical history
- Former tobacco user (quit 2 years prior to admission)
- No drug use
- Worked as an office assistant
- Has two pet dogs and four pet macaws
- No family history of lung disease
- Not taking any prescription medications
Physical Exam
- BP: 116/65, Pulse: 105, T: 37°C, RR: 28, SpO2: 89% on HHFNC (60L; 100%)
- Pulmonary: Tachypneic, in respiratory distress, crackles throughout
- Cardiovascular: Tachycardic but regular, no murmurs
- Extremities: No edema
- Skin: Palms with purplish discoloration and erythematous papules
Radiography
Figure 1. Initial portable chest x-ray.
Which of the following should be done next?
Cite as: Calhoun K. July 2021 Critical Care Case of the Month: When a Chronic Disease Becomes Acute. Southwest J Pulm Crit Care. 2021;23(1):1-4. doi: https://doi.org/10.13175/swjpcc023-21 PDF