Case Part 1: The Man who Lost His Breath

Instructions:

It’s time to meet our patient, Bob! Below is the transcript of your interview with him in the Emergency Department. You’re going to be asked to think like a doctor here to help diagnose and treat this patient!

The Interview

When you are interviewing a patient, you need to collect a lot of key information:

  • Who are they?

    • Name, age, gender

  • What is their overall health like?

    • Past medical history -- any diseases or medical problems they currently have or had in the past

    • Past surgical history -- any surgeries they’ve had

    • Medications

    • Allergies

    • Family history -- any diseases that run in the family

    • Social history -- What is their life like? Do they work? Where do they live and in what type of conditions? Who do they live with? Do they drink, smoke or use drugs?

      • This helps us understand potential causes of their medical condition, as well as develop a treatment plan with the patient that is compatible with their lifestyle.

  • Why are they here today?

    • Chief complaint -- What is the #1 problem that brought them into the hospital today?

    • History of present illness -- the storyline behind this problem that brought them into the hospital

While you are reading through the interview, print this table or create a similar table to fill out with your notes to keep track of all of the information you learn:

Interview Notes

Name

Age

Gender

Chief Complaint

When did it start?

What other symptoms do they have?

Any other important information?

Past Medical History

Past Surgical History

Medications

Allergies

Family History

Social History

Student Doctor (You): Hi, it’s nice to meet you! I am the student doctor who will be taking care of you today. What is your name? What is your age and what gender do you identify with?

Bob (Patient): My name is Bob and I’m 65 years old. I identify as a man.

Source: Verywell Health

Student Doctor (You): I heard you’re not feeling so well. What brings you into the clinic?

Bob (Patient): I’ve been having a hard time breathing.

Student Doctor (You): Can you tell me more about that?

Bob (Patient): It started about a week ago and keeps getting worse. I also think I’ve had a fever. I’ve been coughing and feeling really tired. I don’t know how I got sick because I don’t know anyone around me who has been sick.

Student Doctor (You): What is your health normally like?

Bob (Patient): I have a lung disease called COPD (more on this in the next section) and it affects my life a lot. I usually get a little short of breath when climbing stairs or walking long distances, and cough every day because of my COPD. However, I noticed I am much more short of breath than normal and have been coughing a lot more.

Student Doctor (You): Do you have any other health problems?

Bob (Patient): I also have high blood pressure.

Student Doctor (You): Have you ever had surgery before?

Bob (Patient): I had my appendix removed 40 years ago.

Student Doctor (You): Do you take any medications?

Bob (Patient): I take a pill for my high blood pressure and use some inhalers for my COPD. I don’t know the names.

Student Doctor (You): Do you have any allergies?

Bob (Patient): No.

Student Doctor (You): Do any diseases run in your family?

Bob (Patient): My father had a heart attack and my mom had cancer.

Student Doctor (You): Can you tell me about your day-to-day life?

Bob (Patient): I am retired -- I used to work in construction but can’t anymore because of my breathing issues. I live alone in an apartment in Boston. In the last 2 weeks, I have had a few doctor's appointments and had to go to the pharmacy to pick up medications a few times, as well as go to the grocery store. I used to smoke cigarettes and smoked 2 packs of cigarettes a day for 35 years, but I quit 10 years ago. I do not drink alcohol or use other drugs.

Check-in 2:

Complete the quiz below before moving on

Physical Exam

Nurse Morgan: Would you like me to perform a physical exam on the patient?

Student Doctor (You): Yes please. Could you pay extra attention to how the lungs sound?

Source: UCSD

Nurse Morgan: Most of the physical exam was normal, however, the lungs do not sound clear. Here are the sounds I’m hearing in the lungs:

Crackles and Wheezing

Student Doctor (You): Thank you so much. What are the patient’s vital signs?

Nurse Morgan:

Heart Rate (beats per minute)

Blood Pressure

Temperature

Oxygen saturation

Respiratory Rate (breaths per minute)

Patient

95

120/70

102F

85%

25

Normal

60-100

110-140/60-80

98.6F

95-100%

12-20

Key:

Heart rate - also known as the pulse. How many times your heart beats a minute.

Blood pressure - the pressure in your blood vessels when the heart is squeezing (number on top= systolic blood pressure) and when the heart is relaxed (number on bottom= diastolic blood pressure).

Temperature - body temperature

Oxygen saturation - percent of hemoglobin (protein in blood that binds oxygen) that is currently carrying oxygen

Respiratory rate - how many times you breathe in a minute

Check-in 3:

Complete the quiz below before moving on:

Nurse Morgan: I rechecked Bob’s vitals after I gave him the treatment, here they are:

Heart Rate (beats per minute)

Blood Pressure

Temperature

Oxygen saturation

Respiratory Rate (breaths per minute)

Patient

95

120/70

102F

90%

21

Normal

60-100

110-140/

60-80

98.6F

95-100%

12-20 Check-in 4:

Check-in 4:

Complete the quiz below before moving on