Case 1

Case 1. Cough (Bronchial asthma)

Author: Serhii Sazhyn

Case outline

You are a doctor of the admission department. When you come on duty nurse informed that three patients waiting for doctor.

In the first stage students are invited to evaluate and establish the priority of emergency aid.

1. Oksana, female, 34 y.o., with complaints on severe headache in right temporal area, nausea. The pain occurred evening yesterday. Despite to took painkiller drugs pain intensity increased. Patient told that similar symptoms she had before.

2. Oleksii, male, 62 y.o., informed you about discomfort in left part of the thorax this morning and decided to come for consultation in hospital. Suddenly he felt worst the pain was stronger. Till he waiting in queue he suddenly felt worse himself, the pain intensified. Physical examination: in consciousness. Overweight. Skin is pale. Vesicular breathing during lung auscultation, 18 breath/min. Tones of the heart are rhythmic, a bit muffled. Heart rate - 94/min, BP - 140/90 mm Hg. Abdomen and other internal organs without pathology. You gave one tablet of Nitroglycerin and asked him to wait 5-10 minutes in patients' room.

3. Maskym, 45 y.o, male. Complaints about dry cough more at night, shortness of breath, increased body temperature up to 37.1oC. You have suspected respiratory infection and asked nurse to check body temperature of the patient.

Who of the patients most requires attention?

Choice 1. You examined Oksana, got more information about history of the disease and life. You suspected migraine headache and calmed down the patient that this condition is not danger for her life. You invited her to contact a neurologist as soon as possible.

Choice 2. The nurse reported that the general condition of patient with heart pain has improved after taking nitroglycerin. You have recommended an ECG and sign up for a cardiologist consultation. Also you have given advice about emergency treatment of angina attack.

Choice 3. You decided to continue examination of the patient with dry cough. The body temperature is 36.9oC, skin is pale. Heart rate 96/min. Respiratory rate 28/min. You have heard hoarse breathing with dry and moist rales during lung auscultation. During conversation patient has told that dry cough occurred few month ago after respiratory infection, symptoms have intensified in recent days. 

The second stage involves the ability to carry out tactic of diagnostic and further monitoring of bronchial asthma.

Learning outcome for VP case

  • providing emergency care in patient with asthma attack
  • clinical symptoms and syndromes in bronchial asthma.
  • peculiarities of asthma in adults, depending on the severity and level control.
  • laboratory and instrumental investigation in asthma.
  • Differential diagnosis of asthma and bronchial obstruction syndrome.

Medical error

  • mis-triage,
  • ignorance,
  • system error;
  • poor team working,
  • fixation.