Health History Diagnosed with asthma as a child (age 7)

Ben was out for a jog, where approximately 20 minutes into the run he developed severe shortness of breath and tightness in the chest. An ambulance was called and transported him to hospital. SOCIAL: Ben, a university graduate, lives with parents and two younger siblings. He is a very fit, young adult male who plays competition football. PRESENTATION: Patient Complaints: Severe dyspnoea No Loss of consciousness Meds Salbutamol inhaler Health History Diagnosed with asthma as a child (age 7) He has presented to hospital on two previous occasions for asthma related symptoms. Following his last admission 2 years ago he had Pulmonary Function Tests: FEV1/PEFR 80% of predicted, PEFR variability 30% On Examination A – Patient talking in single words, pursed lips B – Spontaneous, resting RR 34, severe dyspnoea Short shallow breathes, with use of accessory muscles Tightness in chest Dry cough Peak expiratory flow rate ?140 ml Auscultation - ?BS, with diffuse wheezes, auditory inspiratory and expiratory wheeze Percussion: hyperresonant SpO2 93% on 4L O2 C – Resting PR128, BP 90/60, centrally warm and perfused Elevated JVP +5 cm D – GCS 15, PERL 3+, E – Temp 36.7, no complaints of chest pain 2 F – RR 34, BP 90/60, resting PR128, Patient catheterized urine output low 40mls/hour BSL 5.9 I – Pulmonary function tests – see above ECG – Normal, no signs of ST elevation Bloods – ABG: Ph7.35, PaCO2 45mmHg, PaO2 70mmHg, HCO3 24mmol, BE +4 Chest X-ray – Normal, hyper-inflated with flattening of diaphragm Bloods - NAD Glossary of terms and abbreviations NAD No abnormality detected ABG Arterial Blood Gas BP Blood pressure ET End Tidal CO2 is the amount of CO2 in exhaled gas GCS Glasgow comma scale LOS Loss of consciousness RR Respiratory rate PERL Pupils equal and reacting to light PMH Past or previous medical history PR Pulse Rate RR Respiratory Rate SOB Short of breath SpO2 Saturation of oxygen onto haemoglobin in arterial blood # Fracture (L) Left (R) Right