A 63 y/o woman arrives in the ED in respiratory distress. The ambulance crew who transported her wasnt able to obtain any information about her past medical history but did her bag of medicine which include furosemide(Lasix).
On exam, her temperature is 36.5c(99.5f), her BP was 220/112mmhg, HR 130bpm, RR 36bpm. The patients skin is clammy, cool, and diaphoretic and she can only answer yes-or-no questions because of dyspnea. she has jugular venous distention to the angle of the jaw, rales in both lung fields, and +2 pretibial edema bilaterally. her heart sounds are regular although tachycardic with s4 gallop.
1. What is the most likely diagnosis?
2.what is the most appropriate next step?
I suspect it to be right congestive heart failure.. im just assuring it.. im quite nervous on my case press this coming thursday.. our professor says if the diagnosis was wrong we cant proceed to present our case pressentation.. thanks for bearing with me..
Friday, January 23, 2009
Can you help me diagnose this?
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