1. Case no 1( week 1- April5- April11)
2. Case No.2 (week  april  11- april 17)

3. Case No 3 (week April 24th-May1st)
A 20-year-old woman comes to the ED with a 2-week history of gradually progressive shortness of breath, orthopnea, and dysphagia. She reports an 18-lb (8 kg) weight loss and subjective fevers over the same period of time. She also describes chest tightness and a nonproductive cough. The patient was empirically treated by her private physician with a course of antibiotics without improvement 7 days ago. She was told that there was an abnormality on her chest radiograph and a chest CT scan was performed, but she did not follow up on the results. She is a never-smoker and has no history of asthma. On physical examination, the patient is in mild-to-moderate respiratory distress with a respiratory rate of 32/min; BP, 152/84 mm Hg; and pulse rate of 130/min. Her temperature is 38.4° C. Neck examination reveals jugular venous distention. On lung examination, there is diff use wheezing. Her current posterior-anterior and lateral chest radiographs are shown (Figs 1-A, 1-B). A chest CT scan is ordered, but the patient becomes more short of breath (accentuated when supine in preparation for the CT scan), restless, and confused. Her respiratory rate increases to 40/min, and her oxygen saturation is 88% when breathing 50% oxygen by face mask.

The next step in this patient’s management should be:

A. Awake intubation in the semiupright position.
B. Rapid sequence intubation.
C. Noninvasive mechanical ventilation.
D. Emergency tracheostomy.
also comment on the CT and Chest X Ray

Please come back on Tuesday for answer.


Air Bronchogram Sign.

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