Clinical Case 028: Pink puffer with extra puff
This case come from Dr Adrian Goudie, Fremantle Hospital (where I haunted the wards as an intern). Adrian is an Emergency Physician who is part of the excellent Ultrasound Village team – these guys run great basic training courses in ED and procedural US. Check out their website as it has some golden learning resources and images as well as flyers for their upcoming courses. I did their ECHO basics course a few weeks ago and learned a heap of stuff I probably should have been taught in Med School! Fro me this one day of learning demystified cardiac anatomy and ECHO imaging in a commonsense, practical way – two thumbs up from me!
So here is Adrian’s case:
Elderly lady with severe CAL who was in extremis, marked dyspnoea. Acute decompensation ? cause. Here is her initial CXR:
Can you see any cause for her acute deterioration?
Quick – make a call before she crashes!
Adrian says: “everyone was keen [to put in the ICC] until they realized how low it would have to go and suddenly I was alone in the department. I certainly don’t enjoy putting these in – in addition to the usual kit I also made sure I had “spare underpants x 1” available! Anyway – went in well and she improved immediately.
Nice work Adrian.
I would be very nervous that this may be a giant bullae and not a pneumothorax, without any previous imaging to compare or a CT. When push came to shove I am sure it took some cajones to put the tube in and see if she improved!