Respiratory Case Study 

Inez Sebastian, a 53 year old obese librarian, is brought to your emergicare agitated and complaining of shortness of breath, chest pain, dizziness, and "feeling bad".  She states that she has not felt well for the past three days, spending most of these days "sitting in a recliner so she could breathe".  Earlier today, her husband reports that she coughted up a lot of blood-tinged mucous during a "coughing spell".  She states that she has a chronic cough, but today's "coughing spell" was different to her usual cought.  She smokes 1/2 - 1 pack of cigarettes a day of unfiltered cigarrettes.  She relates that she has been trying to quit for several months and was smoking 2 - 3 packs a day for the past few years.

On physical exam, you note that she is pale.  She has a pleural friction rub, diminished breath sounds on the left side and hyperresonance on the right side of her thorax.  Her hands and feet are cool and slightly cyanotic with slow capillary refill. Her ABGs indicate moderate hypercapnia and a pO2 of 64.  She is tachypneic with sinus tachycardia and occasional PVCs.  Her temp is 101.4, BP is 102/64.  A STAT chest x-ray indicates early emphysema and a moderate, non-specific infiltrate in a wedge shape bordering the left pleura.  CBC indicates an elevated WBC count.   She is diagnosed with COPD and Pulmonary Embolus.  She is transferred to the nearest hospital for continued care.

Construct the 3 flowcharts listed in this overview of Mrs. Sebastian to explain the pathophysiology of her symptoms. 

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