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chameed

Re: Patient with sudden dyspnea and no Clues !

While it is true that chest may be clear in some cases of PE, that does not exclude the possibility. PE would be on top of my list of differential. ARDS is a fancy name given to the end stage of many diseases and a good clinician will always tell you that patient had this disease and despite all my efforts, developed ARDS and died. Tachypnia and tachycardia in a young female with sudden onset would lead me to V-P scan etc first. Coarse creps can be heard but PE is lethal and should be ruled out as quickly as possible.

docosama

Re: Patient with sudden dyspnea and no Clues !

In patients with pulmonary embolism, chest in most cases remains clear. This patient had a picture of ARDS, chest full of cretps.

chameed

Re: Patient with sudden dyspnea and no Clues !

Pulmonary embolism from either pelvic or lower extremity veins. Did you look for the source of emboli and did you consider the differential? Embolism is No. 1 cause of death in women of reproductive age, at least here in the US.

docosama

Patient with sudden dyspnea and no Clues !

A week back we encountered a strange female young patient 25 years of age. She presented with 1-2 hour history of sudden onset of dyspnea, restlessness and drowsiness. She never had any past history of any cardiac or respiratory illness. However, she had off / on complaints of loose motions and arthalgias from many years.

On examination, she was found to be sweaty, drowsy, restless. Her BP initially was 150/100 with pulse of 130/min regular. There were coarse crepts in her chest upto apices. Her heart sounds were normal. Rest of the examination was normal.

Her ECG had only sinus tachycardia and Chest x-ray was absolutely clear, against the clinical picture.

She was initially treated on the lines of Acute Left Ventricular Failure.

Later on, despite giving 100-200 mg iv diuretics, patient's condition never improved.

Another diagnosis of "Acute Respiratory Distress syndrome" was made. After intubation, her heavy secretions were sucked out, and then she was put on Ventilator, at SIMV mode with FiO2 of 80% with was given. She was given extended spectrum antibiotics.
After suction of secretions, her chest became clear for a few minutes, and again became full of crepts.

She went in Cardio-pulmonary collapse and we were unable to revive her again. Her total stay in the hospital was just 12 hours.

Differentials were:

1. ARDS
2. Poisoning ? Organophosphorus ?

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