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Quick clinical question for you folks:
Had a patient the other day with what I thought was a classic presentation of pneumothorax, but turned out to be a massive PE.
35 year old female hx cervical CA with mets to lymph. CC of severe, sudden-onset shortness of breath. Auscultation of the lungs showed clear lungs on the right with good air movement and totally absent left-sided fields. She had sternocleidomastoid retractions and +JVD, but she was normotensive and tracheal deviation was not appreciated. SpO2 was around 80% on 15 lpm, which did not provide any relief of symptoms. Non-invasive EtCO2 was 15mmHg with a "normal" (but obviously hypocapnic) waveform. 12-lead was unremarkable (Sinus tach, I believe).
She denied all other symptoms.
Am I missing anything in the differential here? I was kind of expecting a two-part waveform on the EtCO2, showing delayed (or no) emptying of the left lung. I considered the low, short waveform to possibly be indicative of either 1) small amount of CO2 being exhaled, or only from one lung, or 2) V/Q mismatch secondary to PE. But she lacked any symptoms other than SOB to differentiate.
Had a patient the other day with what I thought was a classic presentation of pneumothorax, but turned out to be a massive PE.
35 year old female hx cervical CA with mets to lymph. CC of severe, sudden-onset shortness of breath. Auscultation of the lungs showed clear lungs on the right with good air movement and totally absent left-sided fields. She had sternocleidomastoid retractions and +JVD, but she was normotensive and tracheal deviation was not appreciated. SpO2 was around 80% on 15 lpm, which did not provide any relief of symptoms. Non-invasive EtCO2 was 15mmHg with a "normal" (but obviously hypocapnic) waveform. 12-lead was unremarkable (Sinus tach, I believe).
She denied all other symptoms.
Am I missing anything in the differential here? I was kind of expecting a two-part waveform on the EtCO2, showing delayed (or no) emptying of the left lung. I considered the low, short waveform to possibly be indicative of either 1) small amount of CO2 being exhaled, or only from one lung, or 2) V/Q mismatch secondary to PE. But she lacked any symptoms other than SOB to differentiate.