Ruben James is an 84 year-old man who collapsed at home and was brought by
ambulance to the hospital.
- His wife indicates he had become very
short of breath and then collapsed.
- He has a 1 year history of congestive
heart failure (CHF).
- He has a history of hypertension,
coronary atherosclerosis and myocardial infarction 5 years ago.
- Physical exam:
- Elderly man in acute distress
- Height = 70", weight = 150#
- T = 98F, pulse = 110, R = 28
(labored), PB = 90/70.
- Rales in lung fields bilaterally.
- Rales (RALLS) tend to be heard at the
end of inspiration and sound like crackling leaves or hairs rubbing
- They reflect the water in the alveolar
spaces and are thought to be the sound of the collapsed alveoli snapping
- Third heart sound is present
Jugular venous distension, liver is
- Skin is moist and gray, 3+
Mr. James wife indicated her husband has had
a poor appetite over then past 6 months, but she didn't think he had
lost much weight. His difficulty with eating was due to nausea and
shortness of breath.
When asked, Mr. James says:
“I get enough to eat,
just not very hungry.”
admitted to cardiac care and started on
dopamine drip and IV diuretics.