Pulmonary
The Southwest Journal of Pulmonary and Critical Care publishes articles broadly related to pulmonary medicine including thoracic surgery, transplantation, airways disease, pediatric pulmonology, anesthesiolgy, pharmacology, nursing and more. 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.
April 2018 Pulmonary Case of the Month
Ashely L. Garrett, MD
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
A 74-year-old woman with known chronic obstructive pulmonary disease (COPD) presented to emergency department on 2/4/18 with dyspnea. She had been hospitalized at another hospital from 12/29/17 - 1/30/18 for a COPD exacerbation and health care associated pneumonia described as a cavitary pneumonia. She was treated with various doses of systemic steroids and antibiotics. Her course was complicated by atrial fibrillation with a rapid ventricular response. She eventually was discharged to a skilled nursing facility.
Past Medical History, Social History and Family History
She has a known history of COPD with an FEV1 of 22% of predicted and is on 2L/min of O2 by nasal cannula. There is also a history of:
- Hypertension.
- Hypercholesterolemia.
- Paroxysmal atrial fibrillation, not on anticoagulation.
- Right 4 mm PICA aneurysm
She lives in rural Kingman, AZ with some dust and outdoor bird exposure.
Family history is noncontributory.
Medications
- Alprazolam 0.25 mg p.o. b.i.d.
- Symbicort two puffs inhaled b.i.d.
- Diltiazem 120 mg p.o. q.12h
- Disopyramide 150 mg p.o. q.6h
- Furosemide 20 mg p.o. daily
- Levalbuterol 0.31 mg q.6 days p.r.n.
- Meperidine 50 mg p.r.n. pain
- Metoprolol succinate 12.5 mg p.o. b.i.d
- Prednisone 10 mg p.o. daily
Physical Examination
- Vitals: BP 110/65 mm Hg, P 130 irregular beats/min, T 37° C, Respirations 20 breaths/min
- General: Appears in mild respiratory distress
- Lungs: Distant breath sounds
- Heart: Irregular rhythm with distant tones
- Abdomen: no organomegaly, masses or tendernesses
- Extremities: No edema
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Cite as: Garrett AL. April 2018 pulmonary case of the month. Southwest J Pulm Crit Care. 2018;16(4):174-82. doi: https://doi.org/10.13175/swjpcc050-18 PDF