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“I am having trouble breathing.”
History of Present Illness
RM is a 64-year-old male who comes to the emergency department with fever, shortness of breath, and cough. He complains of a productive cough with discolored sputum for the past week. Over the past few days, he complains of fever, chills, and pressure on his chest when he coughs. He has been hospitalized two times in the past year approximately 6 months ago for COPD exacerbation.
Chronic obstructive pulmonary disease (COPD)
Father: had COPD and HTN and passed away from a stroke
Mother: is 88 y/o, alive, with coronary artery disease
He lives alone, never married.
He smokes 1 pack per day for 30 years. He quit 5 years ago.
He drinks beer occasionally, 1 to 2 times per month.
Anoro Ellipta 62.5 mcg/25 mcg: 1 puff daily
Albuterol metered-dose inhaler: 2 puffs every 4 hours as needed for shortness of breath
Lisinopril 10 mg PO daily
Metformin 1000 mg PO twice daily
Temp 101.5°F, P 128, RR 24, BP 118/78 mmHg, SpO2 70%, Ht: 5′6″, Wt: 72.7 kg
Chronically ill-appearing male with shortness of breath in moderate distress.
Normocephalic, atraumatic, PERRLA, EOMI.
Diminished breath sounds and crackles bilaterally.
Soft, non-distended, nontender.
Normal male genitalia, no complaints of dysuria, or hematuria.
Na 137 mEq/L
RBC 3.8 × 106/mm3
WBC 23.1 × 103/mm3
Procalcitonin 1.9 ng/mL
K 4.1 mEq/L...