TBL 4

Case for Discussion

• Puan Rojia a 42 years old administration assistant in a local school presents with dyspnea that occurs suddenly on her way back to Kota Kinabalu in KLCC.

• Been admitted in PJH since 27th Dec 2011.• Presents with productive cough, with

greenish-yellow sputum.• Does not wheeze.

Chief Complain

Past Medical History

• Have history of asthma for more than 25 years.

• Frequent asthma attacks usually during stress or exertion.

• Severe allergy to cat furs and dusts.

Systemic Review

• No HPT.• No DM.• Have symptoms of anemia.

Current Medication• Breathing using the oxygen supply. To supply

adequate O2.• Inhaler is given every 2 hours. • Budesonide. Antiallergy agent.• Salbutamol. β2 adrenergic receptor agonist,

bronchodilator.• Afuroxime. 2nd gen cephalosporin, URTI

Current Medication

• Hydrocort. Anti-inflammatory• Prednisolone. Anti-inflammatory• Ferrous fumarate. Supplement to treat

anemia• T. folate. Supplement to treat anemia• Vit B complex. Supplement to treat anemia• Vit C. Supplement to treat anemia

Drug Allergies

• Have no known drug allergies

Family History

• No family history of asthma.• Uneventful family history.

Social History

• Lives in Lahad Datu with her family.• Complains that her working environment is

full with people who smokes.• Patient does not smoke or consume any

alcohol.

Examination

• On examination the patient is sitting on her bed, breathing with the oxygen supply.

• RR of 20/min. (12-18 at rest)• BP of 120/81. • T of 37°C.

Hands Examination

• No signs of clubbing.• No peripheral cyanosis.• Hands are pale.• No palmar erythema.• Nails are pale.

Arms Examination

• PR of 96 beats/min. (60-100)• Volume is normal and pulse is regular.

Face and Neck Examination

• No jaundice.• No pallor.• No central cyanosis.• Lymphadenopathy?• Raised JVP?• Trachea centrally located?

Investigations

• Arterial Blood Gas. To check for her pO2 and pCO2 levels

• Electrolytes. To detect for any metabolic disorders• FBC. To check for infections• Blood smear. To check for the morphology of the RBC• ECG. To exclude any cardiac diseases• Urine FEME. To detect for any metabolic complications• Sputum C&S. To check for the causative agent of her

URTI

• pH 7.44 (7-7.7)• pCO2 25mmHg (15-125)• pO2 141mmHg (14-410)

Arterial Blood Gas

Electrolytes

• cNa+ 43mmol/L (120-180)• cK+ 2.4mmol/L (2.0-8.0)• cCa+ 1.02mmol/L (0.50-2.50)• cCl- 101mmol/L (85-140)• cGlu 11.6mmol/L (2.0-15.0)

Investigation – what we would do

• Spirometry. To detect any obstruction/restriction

• Chest X-ray. To detect any mass/consolidation/pneumothorax/pulmonary edema