Case of a bedridden female with shortness of breath

Abstract

Clinical introductionA 57-year-old woman nursing home patient with diabetes, hypertension, and a prior haemorrhagic stroke presented to our emergency department with progressive dyspnoea, cough with white sputum and low-grade temperature. On arrival, the patient was tachypnoeic, using accessory muscles and oxygen desaturation was noted. Physical examination showed no jugular vein engorgement, trachea was not deviated and auscultations revealed bilateral equal breath sounds with bi-basilar rales. Despite supplemental oxygen, the patient required intubation and was admitted to the intensive care unit (ICU). However, in the ICU, the patient's saturation continued to fluctuate despite varying ventilation settings. The postintubation X-ray is shown (figure 1).emermed;emermed-2019-208918v1/F1F1F1Figure 1Postintubation X-ray. QUESTION: What is the most likely cause of respiratory failure in the patient?Pulmonary oedema.Pneumonia.Pneumothorax.Foreign body aspiration.For answer see page 2.