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A 44-Year-Old Woman Presents to the ED With Agitation, Dyspnea, and Hypotension

Francesco Mojoli, MD; Anita Orlando, MD; Silvia Mongodi, MD; Antonio Braschi, MD
Author and Funding Information

aDepartment of Surgical, Pediatric and Diagnostic Sciences, University of Pavia, Pavia, Italy

bAnesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

CORRESPONDENCE TO: Francesco Mojoli, MD, Fondazione IRCCS Policlinico San Matteo, Anesthesia and Intensive Care 1st, Viale Golgi, 19, 27100 Pavia, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(5):e137-e139. doi:10.1016/j.chest.2015.11.033
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Published online

Extract

October 9, 2013

3:00 pm

The rescue team is called for respiratory distress in a 44-year-old woman, who is found agitated and tachycardic, with BP 100/65 mm Hg. She is brought to the ED with the diagnosis of panic attack.

In the ED she becomes more hypotensive (BP, 90/60 mm Hg), so she is shifted to an acute-care bed and given intravenous fluids. Arterial blood gas analysis shows compensated lactic acidosis and hypoxemia (pH 7.38; lactates, 7 mM; Paco2, 27 mm Hg; Pao2, 60 mm Hg). Further history reveals chronic anemia and hemorrhoids; digital rectal exploration shows purulent fluid. A surgical consultation is requested (it having been determined that there was no need for urgent surgery).

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