A 24 year old male is admitted with acute severe asthma. He is treated
initiated with 100% oxygen, nebulized salbutamol, and IV hydrocortisone.
Ipratropium bromide was added to nebulizers. Despite the initial treatment
there has been no improvement.

A 28 year old male is admitted with acute exacerbation of asthma. He has a
temperature of 38.1 C and a productive cough. He is treated initiated with
100% oxygen and salbutamol nebulizers. Despite treatment, his oxygen
saturation is 88% and respiratory rate is 34 breaths/minute.

A 59 year old man with a medical history of chronic obstructive pulmonary
disease presents to the Emergency Department with breathlessness. He
finds it extremely difficult to breathe while in the supine position and has to
sit up in bed or in a chair at night due to his severe dysponoea. His
respiratory rate is 30 breaths/minute and his heart rate is 110 beats/minute.
His oxygen saturation on presentation was 89%. An arterial blood gas test
was done for him and he was commenced on 100% oxygen however, he is
still dyspnoeic. The results of his arterial blood gas are as follows:pH 7.20
PaO2 11.6 kPa
PaCO2 9.8 kPa

A 24 year old man presents with acute respiratory distress after being
stabbed in the back. The trachea is not deviated, but he has engorged
neck veins and reduced air entry on his right chest. He has a blood
pressure of 80/50 mmHg, a pulse of 135 beats/minute, and a respiratory
rate of 35 breaths/minute.

🗯🗯 عملي الباطنة :

■ keywords on cases :

● Part 1 :
https://t.me/med_Notes2/973

● Part2 :
https://t.me/med_Notes2/975

■ MCQ on cases on dyspnea :
https://t.me/med_Notes2/981

■ MCQ on cases on chest pain :
https://t.me/med_Notes2/1015

■ cases on chest pain :-

58 year old man with a history of type 1 diabetes mellitus and hypertension for 13 years
develops sudden central chest pain and abdominal pain for 45 minutes. The pain radiates to his
jaw. It started while he was driving and it was associated with cold sweating and dyspnoea. He
describes the pain as a burning pain.

A 25 year old male presents to Accident & Emergency with the complaint of substernal sharp
chest pain. The patient claims that the pain is much worse on inspiration. His pas medical
history is insignificant however, he smokes 20 cigarettes daily and drinks 50 units of alcohol
weekly. On examination, his chest is clinically clear and his abdominal examination was found to
be normal.
His vitals are noted as:
Temperature 38 C
Respiratory rate 18 breaths/minute
Blood pressure 110/70 mmHg
Oxygen saturation 97%

72 year old woman is brought in by her husband as she has sudden chest discomfort,
palpitations and epigastric pain which started 1 hour ago. She has been feeling nauseous. She
denies pain radiating to the arms or neck. There are ST elevations seen on leads II, III and aVF on
the ECG. Oxygen has been started. She has been given sublingual GTN and diamorphine which
has improved her chest pain. Her heart rate is 90 beats/minute and respiratory rate is 18
breaths/minute.

A 52 year old man with history of anterior myocardial infarction 3 weeks ago developed a sudden
onset of dyspnoea. He has a blood pressure of 100/60 mmHg, pulse rate of 100 beats/minute,
SaO2 = 88%, and his chest is audible for bilateral crackles. What is the SINGLE best investigation
to determine the underlying cause