Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.
A 57-year-old AAM is admitted to the hospital with shortness of breath (SOB) for 7 days. He has leg edema, which is getting progressively worse, to the point where his scrotum, penis and even lower abdomen are edematous. He does not have chest pain (CP) or abdominal pain. He is morbidly obese and has difficulty ambulating, using a wheelchair at home.
Past Medical History (PMH)
CHF, HTN, DM2, CAD, CRI, BPH, AFib, gout, OA, OSA on home O2 3 L/min and CPAP.
KCl, Coreg (Carvedilol), Zocor (Simvastatin), Flomax (Tamsulosin), Lasix (Furosemide), Clonidine, Percocet (Oxycodone and Acetaminophen), Nifedipine XL, Humulin N (human NPH insulin injection [rDNA origin]), aerosols, Amiodarone.
Social history (SH)
SpO2 94% on 3 L/min.
Morbidly obese, appears mildly tachypneic.
Chest: mild respiratory distress with RR 22, bibasilar rales.
CVS: irregularly irregular rhythm.
Abdomen: obese, soft, generalized anasarca with edema extending up to the level of his umbilicus. His penis and testicles are edematous. He has 2 to 3+ peripheral edema with bilateral Dome wraps on for management of stasis edema.
The CXR shows pulmonary congestion (click to enlarge the image).
CBC, CMP (click to enlarge the image).
Right-sided and left-sided CHF.
The treatment was started with Lasix IV and CPAP. AMI was "ruled out" but he continued to be tachypneic and hypoxic.
What happened next?
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