Respiratory CBL

Respiratory Case!! Discuss!

Case 1: Jamal Chai wala is a 60-year-old male who has presented to the ED with shortness of breath of recent onset. He has a six year history of COPD and is on oxygen at home. Physical assessment reveals the following:, respiratory rate 32, slightly labored, temperature 98.9F. His SpO2 is 90%

Which of the following would be the best treatment to apply initially?

1. 2.5 mg albuterol + 0.5 mg albuterol via small volume nebulizer
2. 2 puffs of 250/50 Advair
3. 40 mg furosemide via IV
4. 0.5 mg ipratropium + 4 mL 20% acetylcysteine via small volume nebulizer

Which of the following is the most likely diagnosis to make at this time?

1. exacerbation of COPD
2. pulmonary edema
3. bilateral bacterial pneumonia
4. influenza

Case 2:

Zardari is a 20-month-old female brought into the ED by her parents because of increasing shortness of breath and cough that has worsened over the past several hours. Upon arrival, the following is noted: pulse 136, respiratory rate 40 and labored with intercostals retractions, temperature 102F. SpO2 93% on room air. 

An occasional ‘bark-like’ cough is noted. The parents state that zardari has had what appears to be an upper respiratory infection for the past two days.

Which of the following is the most likely diagnosis?

1. bacterial pneumonia
2. bronchiolitis
3. epiglottitis
4. croup

Which of the following is a test that would help to confirm the diagnosis?

1. lateral neck radiograph
2. chest radiograph
3. CT of the chest
4. pulmonary function

Which of the following is the best treatment to apply at this time?

1. oxygen via face mask at 5 Lpm
2. oral intubation in the OR
3. tracheotomy
4. 0.5 mL of racemic epinephrine via small volume nebulizer

Case 3:

Afridi is a 31-year-old male who was transported to the ED by EMS after he was rescued from a house fire. He has only minor burns on his body; however, he does have a moderate amount of sooty residue around his mouth and nose. He is alert and anxious and has the following vital signs: respiratory rate 26. His SpO2 while breathing oxygen via nonrebreathing mask is 100% (using a standard pulse oximeter).

Which of the following is the most important diagnostic test to run at this time?

1. chest radiograph
2. CT of the thoracic cavity
3. echocardiogram
4. arterial blood gas analysis/co-oximetry

Given his condition, which of the following data points is the most clinically useful for this patient?

1. COHgb
2. pH
3. PaCO2
4. PaO2

At this point, the patient is most likely developing which of the following

1. flash pulmonary edema
2. bronchospasm
3. bilateral pneumonia
4. ARDS

Case 4
BB is a 34-year-old female transported to the ED following a car crash. Upon arrival, she is alert and anxious and appears to be in respiratory distress. Quick assessment reveals that she sustained trauma to her face, neck, and chest. Her left hemithorax appears to be expanding more than the right. She is receiving oxygen via nonrebreathing mask. Her vital signs are: respiratory rate 36 and labored. SpO2 is 85%. 

Which of the following is the patient’s most likely condition?

1. pleural effusion in the right base
2. acute pulmonary edema
3. tension pneumothorax on the right side
4. cardiac tamponade

Which of the following would be the most effective treatment to apply at this time?

1. intubation and mechanical ventilation
2. chest tube insertion
3. thoracentesis
4. +5 cmH2O of CPAP via full face mask

Case 5
Ronldo is a 58-year-old male who presents to the urgent care center complaining of malaise and shortness of breath of recent onset. He was recently diagnosed with Stage One COPD and was prescribed Spirva 1 puff QD and albuterol 2 puffs PRN. He also admits to smoking ‘about a half pack’ of cigarettes a day.

Examination reveals a slightly cachectic male who appears to be older than his stated age. He is alert and oriented and in moderate respiratory distress. He has an occasional moist nonproductive cough. His vital signs are: respiratory rate 30 and slightly labored, temperature 102F. SpO2 (on room air) 95%.

Which of the following is the most likely diagnosis for this patient?

1. exacerbation of COPD
2. exacerbation of congestive heart failure
3. bilateral bacterial pneumonia
4. asthma

Which of the following would be the most useful diagnostic test to perform at this time?

1. sputum analysis
2. chest radiograph
3. spirometry
4. arterial blood gas analysis

Which of the following would be the most effective treatment to prescribe for this patient?

1. oral antibiotics
2. transfer to acute care hospital
3. oxygen via nasal cannula at 2 Lpm
4. cough suppressants
5. inhaled corticosteroid

Answers

Case 1	Case 2	Case 3	Case 4	Case 5
1	4	4	3	3
1	1	1	2	2
	4	4		1