\nPatient Setting:
\n65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
\nHPI
\nFrequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started ? no seizure activity since initiation of therapy.<\/p>\n
PMH
\nHistory of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.<\/p>\n
Past Surgical History
\nNone<\/p>\n
Family\/Social History
\nFamily: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
\nSocial: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.<\/p>\n
Medication History
\nTheophylline SR Capsules 300 mg PO BID
\nAlbuterol inhaler, PRN
\nPhenytoin SR capsules 300 mg PO QHS
\nHTCZ 50 mg PO BID
\nEnalapril 5 mg PO BID
\nAllergies
\nNKDA
\nROS
\nPositive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
\nPhysical exam
\nBP 171\/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5? 3?
\nVS after Albuterol breathing treatment – BP 134\/79, HR 80, RR 18
\nGen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
\nLaboratory and Diagnostic Testing
\nNa – 134
\nK – 4.9
\nCl – 100
\nBUN – 21
\nCr – 1.2
\nGlu ? 110
\nALT ? 24
\nAST – 27
\nTotal Chol ? 190
\nCBC – WNL
\nTheophylline – 6.2
\nPhenytoin – 17
\nChest Xray ? Blunting of the right and left costophrenic angles
\nPeak Flow ? 75\/min; after albuterol ? 102\/min
\nFEV1 ? 1.8 L; FVC 3.0 L, FEV1\/FVC 60%<\/p>\n","protected":false},"excerpt":{"rendered":"
Patient Setting: 65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-1398","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/1398","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/comments?post=1398"}],"version-history":[{"count":0,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/1398\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/media?parent=1398"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/categories?post=1398"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/tags?post=1398"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}