Diary of Dr Derrick Mukurasi

10:32 am

Ambulance parks

A striking sound of very loud stridor audible over 10 meters away

The nurses rush to the Ambulance

A distressed 64/F known Hypertensive patient awaited in the Ambulance

Bp-160/102mmHg, PR-113bpm, Spo2-82%,

Oxygen cylinder brought

Nasal prongs connected on to the patient

Spo2-92%

I am called in immediately

 

It’s an elderly woman in severe respiratory distressed

Unable to talk with very loud stridor; airway obstruction

The vitals deranged

Patient transferred to the casualty bed

Auscultated the chest; normal heart sounds

But inspiratory and expiration stridor, very loud transmitted breath sounds

RR-42 cycles per minute

 

Quick hx; known Hypertensive on unknown treatment

Acute difficult breathing for 2 days managed in a clinic

No improvement

Mild unproductive cough; low-grade fever; no flue or chest pain

Impression-upper airway obstruction due to?

Laryngospasm? Viral cause?

 

Immediately… epinephrine 1:1000 nebulization 4cycles

To lower and control the BP; nitroglycerin not present; given nifedipine 20mg

Stat..  Iv dexa 8mg Stat given

 

It’s 2 cycles of nebulization -1hr

Patient Bp-143/89mmHg, Pr-103bpm, Spo2-98%, RR-28bpm

Now able to talk; mild stridor on auscultation

 

Quick labs

Cbc-normal

BS-NO mps

No Arterial blood games

No viral PCR assays

No CXR at the emergency unit

Patient CXR done in main Radiology unit

 

Transferred to ICU for close monitoring; steroid therapy is maintained

Steady recovery is noted

Discharged after 3 days

What a joy!

Dr Derrick Mukurasi is a Medical Officer at the Emergency Unit at St. Mary’s Hospital Lacor