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

🗯🗯 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

A 69 year old women had sudden burning chest pain and shortness of breath that started 4 hours
ago. The pain was associated with nausea, vomiting and diaphoresis. Her ECG on admission
shows ST elevation in leads II, III and aVF. Oxygen has been started and she was given sublingual
GTN which has improved her chest pain. She was given aspirin 300 mg by the ambulance crew.
Her heart rate is 70 bpm and respiratory rate is 18/min.

"سَل عنَّا الليل والكتب ومضاجع باتت تشكينا
وجحيمُ الطبِ إذا نشبَ بليالٍ كادت تردينا"

أخر ليالي الطب ومعاها تنتهي الأيام ُالمريرة "إن شاء الله".
الليالي دي على الرغم من صعوبتها ومشاعر الخوف واليأس والجذع اللي بتصيب الإنسان ،
إلا أنها أكتر ليالي نحسُ فيها بمعية الله عز وجل ولطفه بينا وإنها مش بتعدي كل مرة غير بكرمه وعمرها ما كانت بجهودنا.
اللهم لك الحمد ربنا لا نحصي ثناءاً عليك أنت كما أثنيت علي نفسك ، نسألك بفضلك ألا تحرمنا بذنوبنا أجر هذه الليالي وأن تجعلها خالصة لوجهك الكريم، ونسألك تمام فضلك وكرمك وأن تبلغنا أخر يوم في عفو وعافية ورضا منك يا كريم.❤🥰

■ السؤال دا ليه تشخيصه PE :

♤ لأنها جايه ب acute breathless من PE بسبب hypoxia و دا بان عندي low Pao2 و حصل hyperventilation دا دليل انه low PaCo2 و بعد كدا حصل alkalosis

■ ليه مينفعش DKA ؟ لانه بيعمل acidosis

■ ليه م ينفعش severe vomting لانه بيؤدي إلى metabloic alkalosis و دا بيظهر عندي high PH & high HCO3 و Pao2 مش بيقل

■ ليه م ينفعش panic attack ؟ لأنه بيحصل acute alkalosis في عدم وجود hypoxia