Clinical scenario: 22-year-old male with difficulty breathing

You are asked to respond to a coffee shop for shortness of breath


"Engine 62, Squad 61, respond Code 3 to 127 West Elm St for a report of male patient with a sudden onset of shortness of breath."

As you walk into the building a server points you to a booth at the back of the restaurant. Your patient appears to be in obvious respiratory distress and displays increased work of breathing. The patient introduces himself as Jeff and answers your questions by speaking two or three words between shallow, labored breaths.

Jeff says that he was sitting in the coffee shop studying when he experienced a fit of coughing. He has had an upper respiratory infection for the past week with a cough producing yellow-green sputum. After the coughing fit Jeff says that he "just couldn’t catch" his breath. That feeling got progressively worse until he decided to call 911.

Jeff does not have any additional illness, injury or pertinent medical history and does not take any medications. He has an allergy to penicillin which was identified when he was a child. He recently quit smoking after six years of approximately one half pack per day.

Jeff’s lung sounds are diminished in the base of the right side and throughout the left. His vitals are:

  • B/P – 138/68
  • HR – 110
  • RR – 32
  • SpO2 – 78%

Think about these questions as you consider what to do next:

  • What are some potential concerns about Jeff’s presentation?
  • What other assessments would you perform?
  • What is your working diagnosis?
  • Are there any emergency treatments you might consider?

Post your answers below in the comments and view the clinical solution for this patient.

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