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What Would I Do Next? | Jenna’s Story - Part One

Mizuho Morrison, DO, Mike Weinstock, MD, and Jenna
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22:28

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Miz interviews a patient who nearly died from a massive PE. Mike and Miz discuss various factors in her case that make her story a great learning case.

Pearls:

  • Avoid anchoring on a diagnosis of anxiety especially when a patient has abnormal vital signs.

 

CASE: The patient, Jenna, is a healthy 39 year-old female with a history of asthma who presents with calf pain as well as  shortness of breath, lethargy, palpitations and anxiety when lying flat since returning from a trip.

 

Vital Signs:   BP: 140/90, HR 80, O2 saturation was 92%, T 37C, RR 18

 

Physical exam:

Patient had mild wheezing, but exam was otherwise unremarkable.

 

Case continues: The patient was diagnosed with anxiety reaction and discharged home.




ANXIETY PITFALLS

  • Not all that wheezes is asthma - consider cardiac or pulmonary causes.

  • It is unusual for an adult, without a history of anxiety or panic disorder, to present with a new diagnosis of anxiety.

  • Unilateral paresthesias, diaphoresis are highly unusual in patients with anxiety and could represent an aortic dissection.

  • Anaphylaxis could be missed in patients who endorse throat tightening.

  • Confusion is a red flag for a more serious condition.

  • Vital signs are vital - do not write off unexplained abnormal vitals signs in otherwise healthy patients.

 

DIFFERENTIAL DIAGNOSIS

  • Wheezing is, more often than not, secondary to reactive airway disease or viral URI.

  • Calf and leg pain in addition to respiratory complaints is concerning for pulmonary embolism or DVT.

  • Chest tightness and palpitations could represent myocardial infarction, especially in younger women who often present atypically.

  • Pneumonia and pleural effusion can present with chest tightness and wheezing.

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Fibrillate into the Future! Full episode audio for MD edition 208:08 min - 98 MB - M4AHippo Urgent Care RAP - March 2018 Written Summary 487 KB - PDF

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