Acute respiratory failure

A 20-year-old man comes to a general practitioner office complaining of dry, irritating cough, shortness of breath, dyspnoea and increased limitation of physical activity over the past seven days. He has no other comorbid diseases. During examination, the patient is alert, fully orientated but obviously dyspnoic (unable to complete a sentence). On auscultation breathing is diminished in lower lung fields on both sides, tachypnoea. Cardiac rythm is regular, sounds without murmur, tachycardia. Oxygen saturation of the patient's blood is 88 %. What are you going to do next as a general practitioner?

Help

I will place the patient into semi-sitting position and administer oxygen from gas cylinder trough a nasal cannula or a face mask (what is available at the GP). I will call EMS and measure CRP level.

I will measure CRP level. If it is < 8 mg/mL, the cause is probably flu and I will send the patient home to rest in bed.

I will place the patient into the supine position and administer oxygen from gas cylinder trough a nasal cannula or a face mask (what is available at the GP). In case patient’s condition improves I measure CRP levels and decide the next steps according to the results.

I will measure CRP level. In case CPR > 10 mg/mL, I will prescribe antibiotics and tell the patient to come back in 2 days.

years

man

36 /min

115 /min

SpO2

88 %

110/70 (83) mmHg

temperature

37 °C

GCS

EKG

rythm: sinus
action: regular
frequency: 115 bpm

Examination

Alert, unable to complete sentences due to dyspnoea, presents with tachypnoea. On auscultation of the lung fields breath sounds are diminished in lower zones on both sides.