Facial edema, abdominal guarding, and shortness of breath


• Scene – vitals, IV, BG
• En route – vitals, 12 lead
• Hospital – unk


• Response to treatment – unknown.
• Disposition – pt had slight swelling around eyes.


Mark Shelton Paramedic Woodburn Ambulance


Mohamud Daya, MD Professor Oregon Health & Science University

David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Facial edema
• Shortness of breath
• Alcoholism
• Abdominal pain

Differential Diagnosis

• Arrhythmia
• Allergic reaction/urticaria/angioedema
• COPD/asthma/emphysema
• Hepatitis (secondary to ETOH)
• Pancreatitis
• Neoplastic disease
• Withdrawal in the chronic alcohol abuser
• Effects of acute or chronic hypertension
• Electrolyte disorder secondary to poor nutrition (eg, low albumin levels)
• Atypical myocardial infarction
• Metabolic disorder (electrolyte abnormality)

Patient Workup History

• Patient states – he has felt lethargic for the past week, with a runny nose for the same length of time.
• He went to bed feeling normal and woke with a swollen face; could not hardly open his eyes.
• He has not eaten any foods that he knows may have caused these S/S or been exposed to chemicals. “I am normally healthy.”
• En route patient had some tenderness to ABD with guarding. No masses and not particularly firm; had a BM this a.m.

Physical Exam

• CBG – 124
• EKG – SR
• GCS – 15

Editor’s Notes

A significant challenge for patients with chronic disease – in this case, presumed alcoholism – is to determine what is acute and what is chronic. This patient’s facial edema and erythema seem acute. His shortness of breath and abdominal pain should be presumed to be acute until proven otherwise. The patient is also noted to have significant hypertension; this value needs to be rechecked. If verified, his blood pressure #s raise concern for long-term risk of stroke and other disease. The patient’s facial and eye swelling appear allergic. Antihistamine treatment in the field may be considered. ‎

-Dr. David Spiro with Dr. Mo Daya


• Gender: Male
• Age: 58 years
• Height: Not Available


• Temperature: 98.3 F/36.8 C
• Blood Pressure: 190/99
• Heart Rate: 84
• Respiratory Rate: 16
• Pulse Oximetry: 100%

RA Signs and Symptoms

Severe facial swelling, hypertension

History Medical

• PMH: None
• Allergies: None
• Dispatch info: HTN, dizzy


• Lives alone, PPD smoker, drinks about 6-10 beers per day; works in woodworking.


• None

Related videos