In the scenario presented to us in the Bate’s video, we saw Devin, a 14-year-old male patient with a chief complaint of cough, trouble breathing, and a recent cold. He reports that he cannot catch his breath and that his chest felt as if it was closing in on him. Devin’s mother gives a brief history of his current symptoms reporting a subjective fever and coughing episodes that occur two times were week on average. She also explains that he has been suffering from dry skin with rashes and patches to his body.
What preliminary diagnoses are you considering at this time?
Childhood asthma
Pneumonia
Vital upper respiratory infection
What areas of physical examination are important for this patient?
Vital signs: normal temperature, heart rate 90 bpm, respirations 20/min, blood pressure 120/75 mmHg, height: 5’3, weight: 69 kg, BMI: 27
Skin inspection: dry with rashes and patches (commonly seen in patients with asthma)
Pharynx (tonsils): enlarged (can be contributed to obesity and results in snoring)
Lungs: intercostal retractions present, bilateral expiratory wheezing with prolonged inspiratory expiratory ratio with use of accessory muscles
Heart: normal assessment
Abdomen: normal assessment
What are your three diagnostic considerations in order of priority?
Childhood asthma: Due to Devin’s recent symptoms of a cold, this may trigger an asthma exacerbation. His positive history of a nighttime cough, intermittent shortness of breath, and trouble breathing with exercise can help point to this diagnosis. Identifying if he has been experiencing nocturnal symptoms that contribute to sleep disturbances and daytime sleepiness can also be associated with acute asthma exacerbations (Trivedi