Question

On escorting your elderly (new) patient from the waiting room to the treatment bay at your Podiatry clinic, you notice that your patient has a loud wheeze. She also appears to be slightly cyanosed, agitated, tense and can only talk to you in phrases.

On resting in the bay area the symptoms do not seem to be subsiding.

Key point:

Upon checking her notes you discover that she has a past history of sudden severe exacerbations and is currently taking B2 agonists via an inhaler (Salbutamol).

1                What is the most likely diagnosis?

2               What patient management protocol would you follow?

3   List all the factors that you should be considering in this scenario.

4   What are the possible causes?

May I have references as well thank you

Answer 1

1). Asthma is the most likely diagnosis of the patient because it is the most common cause of wheezing and the patient is also taking beta-2 agonists (salbutamol), which is used in the treatment of asthma. Acute, untreated asthmatic attack can lead to cyanosis (results from reduced oxygen intake or difficulty in breathing) and agitation.

2). In this case, the patient must be immediately provided with salbutamol inhaler to relieve the bronchospasms and wheezing. The patient must be allowed to have fresh air.

3). The factors to be considered in this scenario include,

• The patient's past history of asthma
• History of asthma triggers
• Patient's age
• Other health conditions such as hypertension and diabetes and medications used for the treatment of same

4). In this case, the elderly patient might have an asthmatic attack, which might be due to the exposure to chemicals in the hospital (for example, the disinfectants used to clean the floor), or anxiety induced. The other causes can be exposed to the cold environment and other allergens.