Asthma
-Vitals notable for [tachypnea, borderline hypoxia]
-Overall sick but non-toxic with coarse breath sounds and wheezes bilaterally. [Mild/Moderate] respiratory distress. No complaints of chest pain other than “tightness” with respirations. Clinical picture is consistent with asthma, especially with known history. Other diagnoses such as PE, PNA, ACS, CHF, allergic reaction seem less likely.
-Starting on nebs and steroids with basic workup and will re-assess.
Re-exam, DC
After nebs and steroids, patient is feeling much better. Breathing is non-labored and wheezes are almost completely absent. CXR and labs unremarkable. Given the patient’s improvement in symptoms, I still think this was likely all due to asthma exacerbation and while more severe malignant processes such as PE, occult PNA, allergic reacion, or ACS are still possibilities it seems highly unlikely. This was discussed with the patient. The patient states they feel much better and would like to go home. Vitals are stable and satting well on RA. The plan is for outpatient therapy with a short course of steroids and scheduled breathing treatments for the next two days. Return precautions were extensively discussed and the patient understands to return for any worsening symptoms or failure to improve.
Re-exam, Admit
After multiple nebs, the patients respiratory status has not improved to the point I feel comfortable sending them home. They still have labored respirations and wheezes. I think scheduled nebs and steroids in the hospital are necessary. I still think other more malignant processes are possible but seem unlikely. Labs and imaging were without major abnormality. Continuing supplemental O2, nebs, fluids and giving magnesium. I have discussed the case with the hospitalist and they agree with plan for admission.
- Last updated January 27, 2023