The patient’s symptoms—chest pain radiating to the left arm, diaphoresis, and nausea—along with his history of hypertension, are indicative of an acute myocardial infarction (AMI). Hypertension is a major risk factor for AMI. Pulmonary embolism, pneumothorax, and aortic dissection could present with similar symptoms but would require further investigation to rule out.
The first priority in managing an acute asthma exacerbation is ensuring that the patient’s oxygen saturation is maintained above 92%. Administering oxygen helps stabilize the patient’s respiratory status. While systemic corticosteroids, magnesium sulfate, and intubation are important in more severe cases, initial oxygen therapy is essential.
The patient is exhibiting signs of hypoglycemia (confusion, sweating, shakiness) and a blood glucose of 50 mg/dL confirms this. The immediate treatment is to raise the blood sugar, either by giving oral glucose (if the patient is conscious) or IV dextrose (if the patient is unconscious or unable to swallow). Insulin is not appropriate in this scenario, and a CT scan would be unnecessary unless the patient’s symptoms persist after glucose administration.
For an asthma exacerbation, the first line of treatment is the administration of a short-acting beta agonist (SABA) such as albuterol, which works quickly to dilate the airways and relieve wheezing and shortness of breath. Oral corticosteroids and nebulized ipratropium are used for more severe or persistent cases, but the initial response to a mild to moderate exacerbation should focus on bronchodilation with SABA.
The patient’s fever, chills, confusion, hypotension, tachycardia, and elevated white blood cell count are signs of systemic infection, and the most likely diagnosis is sepsis. Sepsis is a severe infection that causes organ dysfunction due to a systemic inflammatory response. Although meningitis and pyelonephritis can present with fever and confusion, sepsis is the most likely cause based on his clinical presentation and laboratory findings.
