014 case presentation pulmonary function tests
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This case presentation describes a 32-year-old female patient scheduled for an appendicectomy who has a history of asthma. She presents with appendicitis and is being assessed for anesthesia. Her asthma is generally well-controlled with inhalers, though she had a recent exacerbation requiring oral steroids and antibiotics. On examination, she has wheezing but is not in obvious respiratory distress, with oxygen saturation of 94% on nasal prongs. Laboratory tests and vital signs are stable.
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014 case presentation pulmonary function tests
- 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
- 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