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 Case #10 Pneumonia—by the numbers!
A 62 y/o previously active, healthy and living at home female presents with fever, cough, and chest pain for 3 days. The chest pain is described as achy, located substeranal (no radiation), increased with breathing and coughing, and has been there for 3 days, but is worse now. Chest pain is intermittent, and worse with exertion. PPMH: CAD with a stent placed 6 years ago. (Recent stress test last year was normal) and a Hx of Hypertension. (no hx of Cancer, liver disease, CHF, stroke, diabetes, hypercholesterolemia, or kidney disease). Patient does not smoke.
Meds: Metoprolol, Aspirin
PE: Temp 100.5 F, HR 80, RR 20, PB: 132/80, Sat 96% RA
Patient has rales in the RLL.
The rest of physical exam is completely normal.
CXR reveals RLL infiltrate.
EKG reveals mild flattening of T waves in inferior and lateral leads (no old EKG)
WBC = 12.2 Hbg = 12 Hct = 34
Lytes, BUN, Cr, Glu normal.
1. What is her risk of death from her CAP? Would you recommend out patient treatment?
2. Does her hx of CAD put her at higher risk?
3. Could this patient be also having a NSTEMI? If the cardiac enzymes are elevated (ie the patient is having a NSTEMI)
what is her risk of death?
Click here for answers and to respond
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Previous Articles
Renal (12/26/07)
Cardiovascular (12/19/07)
Pediatric (12/12/07)
Neurologic (12/05/07)
Trauma (11/27/07)
Trauma (11/20/07)
Neurologic (11/13/07)
Pediatric (11/12/07)
Cardiovascular (10/29/07)
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