Case Study #1

Severe Epigastric Abdominal Pain

Sudden onset

Radiation to the back

Continuous and increasing intensity

Mild relief with forward-leaning

Associated Symptoms

Dyspnea

Elevated heart rate (130 bpm)

Oxygen saturation at 92%

Initial Evaluation

Normal vital signs (except for tachycardia)

Temperature: 37.2°C

Blood pressure: 100/70 mmHg

Physical Examination

Epigastric tenderness

Otherwise unremarkable abdominal exam

Laboratory Tests

Complete blood count: Elevated white blood count (14×109/L)

Normal kidney function, lipase, liver function, serum glucose

Normal C-reactive protein

Normal cardiac enzymes

 Additional Investigations

--> Electrocardiogram: No abnormalities

--> Abdominal X-ray: Ordered to rule out free air under the diaphragm

Intervention

Immediate decision to decompress right pleural cavity with a large-bore needle

Definitive Treatment

Chest tube insertion in the right triangle of safety

Resolution of Symptoms

Complete resolution of abdominal pain and dyspnea

Right lung regains full expansion

Case Study #2
Risk Factors

Chronic smoking (40 years)

Hypertension (on T Amlodipine)

Pre-existing Conditions

Hypertension

COPD Diagnosis

Chronic cough with mucoid sputum (3 years)

Persistent breathlessness (1 year)

Smoking history

Reduced exercise tolerance

 Current Presentation

Shortness of breath (progressive for 4 days)

Wheeze

Cough with mucoid sputum

Dyspnea triggered by upper respiratory tract infection

Physical Examination Findings

Tachypnea (28 breaths per minute)

Use of accessory muscles

Barrel-shaped chest

Reduced chest expansion

Hyperresonance on percussion

Generalized expiratory rhonchi

Fine early inspiratory crepitations

Investigations

Chest X-ray: Hyperinflated chest, tubular heart, absent peripheral vascular markings

ECG: Sinus rhythm with low voltage

Diagnosis

--> Acute exacerbation of COPD due to upper respiratory tract infection

Treatment

Nebulization (ipratropium bromide, salbutamol, normal saline)

Symptom improvement

Discharged after dyspnea resolved

Post-Treatment
Prescribed metered-dose inhaler (Ipratropium Bromide, Salbutamol)

Follow-up appointment in one month

Current Status

Tachypneic but well-nourished and alert

No clubbing or cyanosis

Mildly elevated jugular venous pressure

Reduced chest expansion

Bilateral pitting edema

No organomegaly