April 2018 Pulmonary Case of the Month
Sunday, April 1, 2018 at 8:00AM 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
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