General

Case Study for Monday

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18 Jul 2016 - General
 

Middle aged woman, with background of chronic obstructive pulmonary disease, type 2 diabetes mellitus, hypertension, hypercholesterolaemia, previous cholecystectomy and currently still smoking around 20 cigarrettes per day, was admiited through emergency department, by referal from GP, due to increasing shortness of breath, with productive cough. Patient was unwell for the last 3 days, attended GP due to worsening of symptoms, and was sent in to emergency department. On examination, her oxygen saturation on room air was 82%, respiratory rate of 26, temperature of 37.5 celcius, BP 135/90, and pulse of 98. Chest exmanition showed reduced air entry with coarse crackles on the right lung base, with scattered wheeze. Blood tests showed elevated WCC, neutrophil and CRP. Chest X-ray confirmed consolidation on right lung. Her ABG on room air show Type 2 respiratory failure with acidosis !!!  What is your working diagnosis, and what will be your management plan??