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Patient X – 65 year old male, retired, brought by ambulance on the 12 th of April 2010.

Patient X – 65 year old male, retired, brought by ambulance on the 12 th of April 2010. . DDx. Asthma Pulmonary oedema Upper resp tract obstruction PE Anaphylaxis Exac of COPD. Ix. PEF – if not too ill. Arterial blood gases CXR FBC, U&E, CRP ECG Blood cultures (if pyrexial)

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Patient X – 65 year old male, retired, brought by ambulance on the 12 th of April 2010.

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  1. Patient X – 65 year old male, retired, brought by ambulance on the 12th of April 2010.

  2. DDx • Asthma • Pulmonary oedema • Upper resp tract obstruction • PE • Anaphylaxis • Exac of COPD

  3. Ix • PEF – if not too ill. • Arterial blood gases • CXR • FBC, U&E, CRP • ECG • Blood cultures (if pyrexial) • Sputum culture

  4. Figure 6: Chest x-ray showing a giant bulla occupying more than two thirds of the right hemithorax and compressing the underlying lung upward and towards the mediastinum.

  5. Emphysema • Barrel chest, pursed lip breathing (pink puffer in COPD), use of accessory muscles; Palpation - reduced expansion, hyper-inflated chest and decreased vocal fremitus; Percussion - resonant percussion note with decreased liver dullness; Auscultation - decreased vocal resonance, decreased breath sounds with early inspiratory crackles & prolonged expiration

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