Contributed by Douglas R. Johnson, MD and Robert H. Kelly, PhD
Published on line in April 1999
This 68 year-old white female with a history of coronary artery disease, angina, and chronic obstructive pulmonary disease presented with marked respiratory distress. At admission, the patient was afebrile with blood pressure 132/80, respiratory rate 36-40 per minute, and pulse 110 per minute. Physical exam was significant for extremely labored breathing with diffuse bilateral rales. Cardiac and abdominal exams were unremarkable, and trace peripheral edema was noted in the lower extremities. The patient=s respiratory status continued to deteriorate, and she was subsequently intubated and placed on mechanical ventilation. Intravenous diuretic therapy was initiated for suspected pulmonary edema.