Patient Profile:

Miss Winters, age 25, comes to the emergency department with severe wheezing, dyspnea, and anxiety. She was in the ED only 6 hours ago with an acute asthma attack, which resolved with nebulized albuteral treatments.

Subjective Data:

-Admits to use of albuterol inhaler several times weekly for the last few months

-Asthma symptoms occasionally awaken her at night (about 3 times a week), and she has cancelled several outings with her family due to her symptoms

-Can now only speak in one to three word sentences

-Is allergic to cigarette smoke

-Began to experience increased shortness of breath and chest tightness when she returned home

-Used albuterol inhaler repeatedly at home without relief

-History of pruritic skin lesions that have come and gone since childhood.

Objective Data:

           Physical Examination:

-Using accessory muscles to breath

-Audible inspiratory and expiratory wheezing to auscultation with no air movement in lower lobes of l


-HR = 126/min; Resp = 40/min

-Areas of dry, scaling skin in antecubital areas bilaterally with evidence of scratching

Diagnostic Studies:

ABGs: PO2  = 80 mm Hg

PCO2  = 35mm Hg

HCO3  = 24 mEq/L


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