• Duoneb
• Solumedrol IV
• Oxygen
• IV access
• Dyspnea improved after nebs, solumedrol
• Discharged
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Dyspnea
• Shortness of breath
• COPD exacerbation
• Myocardial infarction
• COPD exacerbation
• Asthma exacerbation
• Pulmonary embolus
• Rib fracture
• Pneumonia
• History
• Physical exam
• CBC/CMP/troponin/UA – all normal
This patient case includes two common nursing procedures: IV insertion and 12-lead ECG placement (see “Supporting Materials” section). This particular patient was noted to have wheezing on exam. It was reasonable to treat this patient with a DUONEB and IV steroids because of his known COPD and multi-year pack history of tobacco smoke. Please note the oxygen saturations were low at triage. There was also a subjective relief of dyspnea after nebulizer treatment. Due to the history of chest pain (likely related to cough) it was also reasonable to exclude myocardial infarction.
-Dr. David Spiro
• Note IV access procedure – preparation is key!
• Presence of wheeze makes pneumonia less likely.
• Patient reported he stopped smoking for 4 days – this provides a potential window for smoking cessation education.
• Chronic Obstructive Pulmonary Disease and Emphysema in Emergency Medicine
• Intravenous Cannulation
• Gender: Male
• Age: 64 years
• Height: Not Available
• Weight: Not Available
• Temperature: 98.1 F/36.7 C
• Blood Pressure: 103/69
• Heart Rate: 88
• Respiratory Rate: 18
• Pulse Oximetry: 94% RA
5 days worsening dyspnea, SOB
• PMH: COPD, HTN, chronic back pain – s/p laminectomy
• NKDA Social
• Tobacco use, Occ EtOH use
• Venlafaxine, Combivent, Metoprolol, clonazepam, trazadone, Vicodin, diuretics
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