Pulmonary physiology

Presentation: History

A.Y. had been in her usual state of health until this morning, when she had a sudden sensation of “tightness” in her chest accompanied by wheezing and shortness of breath. She cannot name a precipitant, but noted that a newscaster this morning reported that this was the coldest day so far of the year. She went to a local emergency department. On initial evaluation, she was found to be tachypneic, tachycardic, hypoxic with oxygen saturation (SaO ₂ ) 80%, and sitting in a “tripod” position (see Fig. 16.1.1 ). On arrival, she received albuterol by nebulizer, intravenous solumedrol (a steroid), and supplemental oxygen by nasal cannula.

She denied sick contacts, fevers, congestion, increased cough, myalgias, chills, sputum production, nausea/vomiting, and recent illness. She also reported no leg swelling or change in number of pillows upon which she slept at night. She has taken all medications as prescribed, including daily leukotriene inhibitor, inhaled corticosteroid, and long-acting β2-agonist therapy in addition to “as-needed” short-acting acting β2-agonists. She reported that cold weather, upper respiratory infections, and ragweed pollen have triggered her symptoms in the past.