You are FY2 in AnE
Christopher Jenkinson is a 60 yr old that has been brought in by an ambulance.
Talk to this patient, and institute the initial line of mgt
APPROACH
Grips
Paraphrase
P1…cough associated with hemoptysis
ODIPARA +TRAC
R/O Sx
Sob
Hrt racing
Chest pain
Fever
FLAWS
ICE
PMAFTOSA …Fhx of CA
Psychosocial
DESA
Smokes but stopped when diagnosed with cancer
Examination , vitals, gpe, chest
bedside CXR…ground glass opacity
Diagnosis…Radiation pneumonitis
Meaning a side effect of one of his cancer treatment called radiotherapy.
MANAGEMENT
*Investigation
Routine…FBC, EUC LFT G/CM
CT chest
*High dose steroids + PPI
*Oxygen
*Monitor him closely while hes on treatment
*Intubation if his breathing fails
I’m I going to die?
IPS
For now we are uncertain as ur condition is end stage, but we will try our best to ensure you are comfortable.
Inform seniors
Safetynet
RADIATION PNEUMONITIS AKA CHEMICAL PNEUMONITIS
Saw this once.
Occurs in cancer patients on treatment.
Basically patient develops difficulty in breathing with cough. Difficulty in daily activities and health decline.
Most times tests eg xray, Ct scan shows no other cause like infection or reoccurence, also lung function test shows decline. It occurs as the lungs become fibrosed and less elastic so lung expansion is reduced.
Caused by high doses of radiation or Combining radiation therapy with chemotherapy.
Symptoms
fever
persistent cough
shortness of breath
chest pain
Examination do
Observation
Physical exam of chest
chest x-ray
CT
lung function test
Management doesn’t cure just takes care of symptoms.
Cough medications
Bronchodilators
Steroids
O2 if very bad
Rest and reduce physical activity that can cause stress
Sleep in 45 degrees use extra pillow.
Avoid extreme weather that can worsen cough.
Inform seniors
Refer to specialist
Safety net