Airway Case Study
A 58-year-old woman presents to her physician’s office, complaining that she is having trouble “getting her breath” when she walks quickly. On further discussion, she states that her head has felt “full” for several weeks now, and it is developing into headaches. Her nose is feeling “stuffy,” and she is having trouble reading her cell phone screen. She is currently taking chlort7halidone, captopril, and metformin. She has tried participating in an exercise and calorie-restricted diet for her weight, but has seen little result over the past 9 months. She has recently started using e-cigarettes for her 27-pack-year cigarette use and has only had an occasional cigarette for the past 3 months. She has been divorced for 5 years and lives alone.
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The most common symptoms of facial and neck swelling aggravated by lying down are related to the venous congestion and elevated upper venous pressures. These require urgent intervention if associated with symptoms suggesting airway compromise (i.e., dyspnea, orthopnea, cough, stridor, hoarseness) or cerebral edema (i.e., head fullness, headache, nausea, lightheadedness, syncope, distorted vision, altered mental status). The rapidity of progression of symptoms, presence of airway compromise, and neurological symptoms are important in triaging the patient for detailed evaluation for etiology versus an urgent …show more content…
Aspiration would be appropriate for symptomatic pericardial or pleural effusions. Symptomatic pericardial effusion would have features of right-sided obstruction, but should also have pulsus paradoxus (drop in blood pressure of > 10 mmHg with inspiration) and muffled heart sounds. A pleural effusion large enough to cause symptoms would have decreased breath sounds in the area of the effusion and perhaps dullness to percussion (an insensitive test).
Choice "C" is not the best answer. Fibrinolytics would be appropriate for pulmonary embolism, an important consideration in this case. The 3-month timespan could be compatible with recurrent chronic embolism, but the signs of right-sided obstruction would only be seen in right heart failure, which would have edema of the lower body, including liver and legs.
Choice "D" is not the best answer. Furosemide would be appropriate for congestive heart failure; in this case, isolated right heart failure. Congestive right heart failure should have edema of the legs and perhaps an hepatojugular
The most common symptoms of facial and neck swelling aggravated by lying down are related to the venous congestion and elevated upper venous pressures. These require urgent intervention if associated with symptoms suggesting airway compromise (i.e., dyspnea, orthopnea, cough, stridor, hoarseness) or cerebral edema (i.e., head fullness, headache, nausea, lightheadedness, syncope, distorted vision, altered mental status). The rapidity of progression of symptoms, presence of airway compromise, and neurological symptoms are important in triaging the patient for detailed evaluation for etiology versus an urgent …show more content…
Aspiration would be appropriate for symptomatic pericardial or pleural effusions. Symptomatic pericardial effusion would have features of right-sided obstruction, but should also have pulsus paradoxus (drop in blood pressure of > 10 mmHg with inspiration) and muffled heart sounds. A pleural effusion large enough to cause symptoms would have decreased breath sounds in the area of the effusion and perhaps dullness to percussion (an insensitive test).
Choice "C" is not the best answer. Fibrinolytics would be appropriate for pulmonary embolism, an important consideration in this case. The 3-month timespan could be compatible with recurrent chronic embolism, but the signs of right-sided obstruction would only be seen in right heart failure, which would have edema of the lower body, including liver and legs.
Choice "D" is not the best answer. Furosemide would be appropriate for congestive heart failure; in this case, isolated right heart failure. Congestive right heart failure should have edema of the legs and perhaps an hepatojugular