linnyc
Forum Newbie
Topics: 7
Posts: 23
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this vignette is from pg. 279 of kap pulmonology notes (2002 ed):
26 yo woman w/ Hx of asthma presents to ER w/ 3d of progressive wheezing and SOB a/f an URT infection. She is taking inhaled albuterol and an otc med for her cold Sx. RR 28, P 110, afebrile. Her right nasal turbinate is edematous and erythematous. There is evidence of wheezing throughout both of her lungs, but no crackles.
so here are the questions...didn't have the answers but i wrote in parenthesis what i thought...please correct me if anyone has the right answers:
1) single drug treatment of choice in this pt? (systemic steroids pulsed?)
2) what are the bad prognostic indicators in this pt? (i would say none based on what kaplan indicates in notes, but i really don't know)
3) 3 days a/f hospitalization, the pt is improving, and you decide to send her home. what is her drug regimen likely to be at this time? (add inhaled steroids?)
4) she comes to you 3 months later for f/u and needs documentation of asthma for her work. a) what will you do now? b) what meds is she likely to be taking now? (a. do PFT a/f methacholine challenge- look for FEV1/FVC decrease that can be reversed with a bronchodilator??? and b. should she be on albuterol and steroids?)
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| bose
Forum Senior
Topics: 33
Posts: 162
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You've answered mostly correct.
#1 - I would say add Inhaled Steroids first..what do you think..
#2 - Bad progostic indicator - cyanosis, 'silent lung' (absence of breath sounds), normalization of PaCO2, pneumonia. These pts have Resp.Alkalosis initially and as their condition worsens they get Resp.Acidosis.
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