# Case Part 1: The Man who Lost His Breath

## **Instructions:**&#x20;

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: &#x20;

* **Who are they?**
  * Name, age, gender&#x20;
* **What is their overall health like?**&#x20;
  * Past medical history -- any diseases or medical problems they currently have or had in the past
  * Past surgical history -- any surgeries they’ve had&#x20;
  * Medications&#x20;
  * Allergies&#x20;
  * 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?&#x20;
    * 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.&#x20;
* **Why are they here today?**&#x20;
  * 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?&#x20;

**Bob (Patient):** My name is Bob and I’m 65 years old. I identify as a man.&#x20;

![](https://lh6.googleusercontent.com/GGDtrKZRHAn6DQmuPJbufXEyOjx2gLxOnWfGvgco5sZkiaHzygPV_LxGe6Z2aS0GZGEIvvKBT1m9M5b_1taeelHoVD_0Z7orlf7rsZxLMDLvBlmCAsVrvaiuiLkTMnBpGXRnax2U)

Source: [Verywell Health](https://www.verywellhealth.com/thmb/LDL2WghLx8tDzhzOm7St4glApf0=/400x250/filters:no_upscale\(\):max_bytes\(150000\):strip_icc\(\)/hospitalstay-5a32aa7e0c1a82003633338b.jpg)

**Student Doctor (You):** I heard you’re not feeling so well. What brings you into the clinic?&#x20;

**Bob (Patient):** I’ve been having a hard time breathing.&#x20;

**Student Doctor (You):** Can you tell me more about that?&#x20;

**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.&#x20;

**Student Doctor (You):** What is your health normally like?&#x20;

**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.&#x20;

**Student Doctor (You):** Do you have any other health problems?&#x20;

**Bob (Patient):** I also have high blood pressure.&#x20;

**Student Doctor (You):** Have you ever had surgery before?&#x20;

**Bob (Patient):** I had my appendix removed 40 years ago.&#x20;

**Student Doctor (You):** Do you take any medications?&#x20;

**Bob (Patient):** I take a pill for my high blood pressure and use some inhalers for my COPD. I don’t know the names.&#x20;

**Student Doctor (You):** Do you have any allergies?&#x20;

**Bob (Patient):** No.

**Student Doctor (You):** Do any diseases run in your family?&#x20;

**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?&#x20;

**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

{% embed url="<https://www.fyrebox.com/play/covid-classroom-quiz-2_GQ6r36oGE>" %}

## Physical Exam

**Nurse Morgan:** Would you like me to perform a physical exam on the patient?&#x20;

**Student Doctor (You):** Yes please. Could you pay extra attention to how the lungs sound?&#x20;

![](https://lh6.googleusercontent.com/Oy-aRKCDf8rWsKoze4E-shaArA6f0ovy82PPcn4cIs_EbwvsmrvDqYdAMBlJAVCMVVn94NjIr5jVbzUG7mLSSq6ZTbAje-oqCjRAxsgT598hZkPytJCItwhgz0bOWw87UNSZlT8d)

Source: [UCSD](https://meded.ucsd.edu/clinicalmed/lungs_auscutation.jpg)

**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:&#x20;

[**Crackles**](https://www.youtube.com/watch?v=LHqqvrm2j6g) **and** [**Wheezing**](https://www.youtube.com/watch?v=T4qNgi4Vrvo)&#x20;

**Student Doctor (You):** Thank you so much. What are the patient’s vital signs?&#x20;

**Nurse Morgan:**&#x20;

|         | **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).&#x20;

**Temperature -** body temperature&#x20;

**Oxygen saturation -** percent of hemoglobin (protein in blood that binds oxygen) that is currently carrying oxygen&#x20;

**Respiratory rate -** how many times you breathe in a minute

## Check-in 3:

Complete the quiz below before moving on:

{% embed url="<https://www.fyrebox.com/play/covid-classroom-quiz-3_m7kynKQyG>" %}

**Nurse Morgan:** I rechecked Bob’s vitals after I gave him the treatment, here they are:&#x20;

|         | **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                            | <p>110-140/</p><p>60-80</p> | 98.6F           | 95-100%               | <p>12-20<br>Check-in 4:<br></p>           |

## Check-in 4:

Complete the quiz below before moving on

{% embed url="<https://benjaminlevy.typeform.com/to/kPnyui>" %}