July 2021 Critical Care Case of the Month: When a Chronic Disease Becomes Acute

No abstract available. Article truncated after 150 words. History of Present Illness A 32-year-old woman with no known past medical history presented with progressive shortness of breath for 2 weeks. She denied having a cough, fever, or chills, but she did have a one-month history of fatigue, weakness, and painful rashes on her hands. PMH, SH, and FH • No known past medical history • Former tobacco user (quit 2 years prior to admission) • No drug use • Worked as an office assistant • Has two pet dogs and four pet macaws • No family history of lung disease • Not taking any prescription medications Physical Exam • BP: 116/65, Pulse: 105, T: 37°C, RR: 28, SpO2: 89% on HHFNC (60L; 100%) • Pulmonary: Tachypneic, in respiratory distress, crackles throughout • Cardiovascular: Tachycardic but regular, no murmurs • Extremities: No edema • Skin: Palms with purplish discoloration and erythematous papules Which of the following should be done next? 1. CT Chest 2. COVID-19 testing 3. Sputum gram stain and …