Sample Consults

SPECIALTY
Pulmonology 

CHIEF COMPLAINT
COPD

COMMENTS TO SPECIALIST
84-year-old female, full code. COPD, morbid obesity, chronic hypoxic respiratory failure on 2L NC, Heart failure with reduced ejection fraction (HFrEF) w/Mitral regurgitation and tricuspid regurgitation (MR/TR) and Ejection fraction (EF) 42%.
Worsening dyspnea is associated with expiratory wheezes, O2 sat at baseline on 2L NC, and a globular filtration rate (GFR) of 55, which is normotensive. Chest radiography (CXR) showed cardiomegaly and vascular congestion. On Lasix 40 mg and Aldactone 25 mg daily added for worsening dyspnea. Her COPD daily maintenance regimen consists of Prednisone 5 mg, Singulair 10 mg, and Incruse 62.5 mg.

Received IM solumedrol and started on high dose prednisone taper, Xopenex QID, inhaled budesonide BID x 7 days. IV was placed for IV cefepime given left shift on complete blood count (CBC).

MAIN QUESTION
How can I optimize her respiratory regimen while awaiting a pulmonary medicine appointment and potentially a sleep study?

For reference only. This eConsult is based on an actual request for specialist consultation. The primary care provider, specialist, and patient are de-identified to protect private health information (PHI).