What is wrong with this CT?

In case you didn’t encounter shortness of breath today!

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

Pneumonia is just uploaded!

377.1 - pneumonia1

Pneumonia chapter written by Mary J O from USA is just uploaded to the Website!

Asthma is just uploaded!

Inhaler

Asthma chapter written by Ayse Ece Akceylan from Turkey is just uploaded to the Website!

I…can’t…breathe!

A New Chapter Is Just Uploaded To The Website!

35.3 - pulmonary congestion

An ambulance crew rushes into your emergency department with a 56-year-old man. He is severely short of breath, sitting upright on the stretcher, using his accessory respiratory muscles, and gasping for air. You find that he is diaphoretic, tachypneic, and in severe respiratory distress. You ask him, “What’s going on?” He replies: “I…can’t…(pauses and inhales a shallow breath)…breathe!”

The paramedics inform you that they received a call from the patient’s wife about 6:30 that morning, saying that her husband was short of breath and sweaty and that he had vomited once. The wife told them that she and her husband had returned from a long trip the night before and that her husband had not taken his “water pills” because he did not want to stop for frequent restrooms breaks during their drive. When they got home, he still did not take his pills because he wanted to sleep through the night. His breathing problems woke him during the night, and he tried to get more comfortable by adding pillows under his head to the point that he was almost sitting up in bed.

You thank the paramedics and turn back to the patient, who now looks even worse. He is more short of breath, and you sense that he is getting tired, about to give up. He looks like he is about to collapse. What is your next step?

by Walid Hammad from USA

Three days of constant shortness of breath

Do you recognize these findings in the US and CT scan?

Turkey
by Elif Dilek Cakal from Turkey.

A 68-year-old with wheezing

copd

Chronic Obstructive Pulmonary Disease (COPD)

by Ramin Tabatabai, David Hoffman, and Tiffany Abramson, USA

A 68-year-old male presents to the emergency department (ED) with audible wheezing, and he is in severe respiratory distress. He is speaking in 2-3 word sentences, and he is diaphoretic and slightly confused. Per the paramedic report, the patient is a two pack per day smoker. On physical examination, the patient demonstrates poor air movement, and you note that he has a “barrel chest.” As you pick up the phone to call the respiratory therapist for airway management, you wonder, “What other interventions should I initiate and are there other diagnoses I should be considering?”

What is the value of BiPAP on COPD?

Touch Me

BiPAP on COPD

The use of BiPAP led to decreased mortality (NNT=10), reduction in treatment failure (NNT=5) and decreased need for intubation (NNT=4).
Answer

Dramatic Diaphragmatic Hernia

In case you didn’t encounter shortness of breath today!

15.3 - diaphragmatic hernia 3

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!