Trouble breathing
CHIEF COMPLAINT: "Trouble breathing."
HISTORY OF PRESENT ILLNESS: A 37-year-old German woman was brought to a Shock Room at the General Hospital with worsening shortness of breath and cough. Over the year preceding admission, the patient had begun to experience the insidious onset of shortness of breath. She had smoked one half pack of cigarettes per day for 20 years, but had quit smoking approximately 2 months prior to admission. Approximately 2 weeks prior to admission, she noted worsening shortness of breath and the development of a dry nonproductive cough. Approximately 1 week before admission, the shortness of breath became more severe and began to limit her activities. On the day of admission, her dyspnea had worsened to the point that she became markedly short of breath after walking a short distance, and she elected to seek medical attention. On arrival at the hospital, she was short of breath at rest and was having difficulty completing her sentences. She denied orthopnea, paroxysmal nocturnal dyspnea, swelling in her legs, chest pain, weight loss or gain, fever, chills, palpitations, and sick contacts. She denied any history of IVDA, tattoos, or high risk sexual behavior. She did report a distant history of pulmonary embolism in 1997 with recurrent venous thromboembolism in 1999 for which an IVC filter had been placed in Germany . She had been living in the United States for years, and had had no recent travel. She denied any occupational exposures. Before the onset of her shortness of breath she had been very active and had exercised regularly.
PAST MEDICAL HISTORY: Pulmonary embolism in 1997 which had been treated with thrombolysis in Germany. She reported that she had been on warfarin for 6 months after her diagnosis. Recurrent venous thromboembolism in 1999 at which time an IVC filter had been placed. Psoriasis. She denied any history of miscarriage.
PAST SURGICAL HISTORY: IVC filter placement 1999. Tubal ligation.
FAMILY HISTORY: She reported that her parents were healthy with no known medical problems. She had five healthy children with no medical problems. There was no family history of lung disease, thromboembolism, pulmonary embolism, stroke, or heart disease.
SOCIAL HISTORY: The patient lived with her five children. She had one partner and was in a mutually monogamous relationship of 2 years. She had smoked 10-15 cigarettes per day for approximately 20 years but had quit smoking approximately 2 months prior to admission. She denied any history of drug use, alcohol abuse, tattoos, or blood transfusion. She had no occupational exposures. There were no pets in the home. She denied any recent travel history.
MEDICATIONS: Ibuprofen PRN.
ALLERGIES: No known drug allergies.
REVIEW OF SYSTEMS: No headaches. No visual, hearing, or swallowing difficulties. No changes in bowel or urinary habits.
PHYSICAL EXAM:
Temperature: 97.1 degrees Fahrenheit.
Blood pressure: 122/89.
Heart rate: 126 beats per minute.
Respiratory rate: 24 breaths per minute.
Pulse oximetry: 85% on room air.
GEN: Well developed, well nourished, pleasant Caucasian woman in mild to moderate respiratory distress, mildly tearful, speaking in short sentences, with a dusky complexion.
HEENT: NC/AT, PERRL, EOMI, there was a pink to purplish cyanotic discoloration about the lips, tongue and eyes, the oropharynx was clear with no lesions, the neck was supple, no lymphadenopathy, no JVD, no bruits, the trachea was midline, there was a normal carotid upstroke.
HEART: Tachycardic, regular rhythm, no murmurs, rubs, or gallops. Normal S1 and S2. The PMI was not displaced. No heave.
LUNGS: Bilateral diffuse crackles, no wheeze, no dullness to percussion.
ABDOMEN: Soft, nontender, nondistended, bowel sounds were present. There was no hepatosplenomegaly. No rebound or guarding.
EXT: No clubbing, no lower extremity edema or swelling, no palpable cords. Negative Homans
