"Medic 5, respond Code 3 to _ for a report of a male patient with a sudden onset of shortness of breath."
As I run toward the coffee shop, I see a young woman standing outside waving us down. She beckons us to follow her to the back of the coffee shop. Inside, we find our patient appearing to be in obvious respiratory distress and displaying increased work of breathing. The patient introduces himself as Jeff and answers my questions by speaking two to three words between shallow, labored breaths.
Jeff says that they were just looking for some food when he experienced a fit of coughing. He says he's had an upper respiratory infection for the past week with a cough producing yellow-green sputum. After the coughing fit Jeff says that he just couldn't catch his breath. The feeling got progressively worse until he decided to call 911.
Jeff says he does not have any additional illness, injury, or pertinent medical history and does not take any medications. He does have an allergy to penicillin which was identified when he was a child. He says he recently quit smoking after six years of about a half pack a day.
I go to take Jeff's vitals. Jeff's lung sounds are diminished in the base of the right side and throughout the left. Jeff's B/P is 138/68, HR is 110, RR is 32, and SpO2 is 78%.
After gathering Jeff's history and assessing him I determine that he is at risk for a spontaneous pneumothorax as a smoker with a recent illness and cough. This differential diagnosis is further supported by Jeff's low pulse oximetry reading and the decreased lung sounds on his left side. Since he does not appear to have a tension pneumothorax, however, I elect to provide oxygen and transport to the nearest clinic.
At the clinic, Jeff is confirmed to have pneumothorax by X-ray. He has a chest tube placed and is admitted for observation. He is expected to make a full recovery.