By Dr Bothwell Shiripinda

1. Case Presentation
Bothwell Shiripinda

2. Patient
• 32/F
• Due for appendicectomy
• Diagnosis; appendicitis
• Weight 71kg
• Height 1.66m
• BMI 25.7

3. Medical History
• Asthmatic diagnosed at 11 yrs of age
• On salbutamol inhaler prn
• Also on beclomethasone inhaler 50mcg every morning
• No other comorbidities

4. control
• Last attack 10 days prior to assessment
• Night time attack not amenable to use of inhaler
• Patient had an URTI at the time
• Required visit to ED- was nebulised with salbutamol and discharged
home on prednisolone (5 days) and oral antibiotics (5 days).
• Had subsequently used salbutamol twice in the 3 days prior to this
assessment.

5. Systemic review
• patient does 2/3 3km runs every week and often needs to use inhaler
mid-run
• No lower limb oedema, no orthopnoea or exertional dyspnoea
• Rest of systems unremarkable

6. • No known food or drug allergies
• Missing lower central incisor
• No cough or flu like illness

7. Social
• Occasional smoker
• Drinks on occasions (2 units of alcohol at most twice a month)

8. Examination
General
• (none of: clubbing, cyanosis, oedema, lymphadenopathy, jaundice,
pallor)
CVS
• Pulse regular, rate 116, normal volume
• BP 112/66
• JVP not raised
• First and second heart sounds present
• No added sounds or murmurs

9. Chest
• Not in obvious respiratory distress
• Wet cough
• Respiratory rate 16
• Scanty bilateral wheezes
• No other added sounds
• Saturation 94% on nasal prongs @ 2L/min

10. Airway
• No neck deformities
• Full range of extension & flexion of neck
• Upper lip bite test normal
• Neck circumference 35 cm
• Mallampati 1

11. Bedside pulmonary function test
• Sabrasez breath holding test – 23 seconds
• Single breath count- 28 sec
• Greene & Berowitz cough – Inadequate cough
• Forced expiratory Time- 7 seconds
• Respirometer – Tidal Volume 433 ml MV 7024 ml
• Bedside SpO2- 94%
• ABG- not available

12. Abdomen
• Unremarkable

13. GUS
• Clear urine
• Volume status: wet mucous membranes, Capillary refill <2 sec,
peripheries warm, radial, popliteal and femoral pulses normal
• Was on ringer’s lactate, having already received 2.3 litres at time of
assessment

14. Metabolism
• Temp 37,8 degrees Celsius
• Glucometer 7,8 mmol/l

15. Drug review
• Used beclomethasone inhaler 50 mcg 7 hours earlier
• Given pethidine 100 mg imi 30 minutes earlier, ceftriaxone 1g iv & 1g
iv paracetamol 30 minutes earlier

16. Investigations
• Blood