P: Hi, I'm Rob and I just feel like I can't catch my breath.

D: OK, how old are you Rob?

P: I'm I'm 50 I'm gonna be 50 soon. 

D: OK, OK, when did this start?

P: Well, like last night I kinda had like an ache on my chest, kind of like here like on the left. I just I didn't do anything really last night and you know I just went to sleep and I got to sleep fine like I just thought maybe I pulled a muscle on this side. But then I woke up and I was like walking up the stairs and I like was kinda having a hard time breathing and I took some Tylenol. It didn't really do anything. Um, and then it just got worse and then a few hours ago is like I could barely walk. And if I'm breathing deep it's like it just hurts. And I feel like I can't like catch my breath like I can't get a good like a good breath in.

D: Um, OK, so I just want to state at this point I would do ABC's, like I would do the vitals and make sure you're stable and then do airway breathing circulation if you weren't before I continue with the history. OK, so. OK, so that's how it started. Um, are you having any chest pain at all associated with that?

P: Like when I breathe in, I get like and it's like an ache. And then if I breathe really deep it feels like a little sharp.

D: OK.

P: I have never had anything like this before.

D: No? OK, that was going to be my next question. On a scale of 1 to 10, how severe is your shortness of breath, 10 being the worst?

P: Um, I don't, I don't know, um. Like I can breathe right now, I can't get like a deep breath, like...

D: Does it? Oh sorry, go ahead.

P: Maybe like you know five or six.

D: OK, OK. Does it hurt when you take a deep breath in? 

P: Yeah.

D: Yeah?

P: Yeah, it's like it's like sharp.

D: OK, sorry, sounds like you're having some pleuritic chest pain. Do you have any coughing associated with that?

P: No no.

D: No? You're not coughing up any blood?

P: No.

D: Any swelling in your legs?

P: I I don't think so.

D: No? OK, how about on exertion? Like when you walk or run, or you know, does it hurt more or does I mean sorry, does your shortness of breath get worse? 

P: Oh yeah, it was like going up the stairs, can't really breathe in after.

D: OK, how about when you're laying down?

P: I don't know. I don't think that's any different. No, I slept fine last night. I got up and when I went up the stairs I was like holy...

D: OK. How about wheezing? Are you experiencing any wheezing? 

P: I don't think so. 

D: OK, how about fevers or chills?

P: No, not that I've noticed, no.

D: OK. Any abdominal pain?

P: Uh, no, no, it's like it aches kind of it, but it's all up here and like kind of in my back a little bit. 

D: OK and, do you think anything triggered this?

P: I don't know.

D: No? OK. And you said this has never happened to you before, right?

P: Right, yeah.

D: Does it get better with you sitting forward?

P: I don't know, like I, I feel like that it's still kind of aching like it doesn't, it's not really like changing very much.

D: OK. OK. OK, any changes in your vision, hearing or smell?

P: No.

D: No? Any rashes?

P: No.

D: No? Weight loss?

P: I, I mean, I've been trying to to lose weight.

D: OK.

P: They told me a year ago I have like high blood pressure so I've been cutting out like salt and trying to walk more. 

D: OK, OK, good. 

P: So I've lost like 15 pounds but like not... Like I've been trying to.

D: OK, OK. 15 pounds, that's good. Are you experiencing any dizziness or you feeling faint?

P: No, just like a I can't get like a good breath.

D: OK, and are you otherwise healthy? You mentioned you have high blood pressure, anything else?

P: No, that's that's like it. I've never had any like chest problems.

D: OK. Have you had any investigations done for your chest like pulmonary function tests, ECG's, chest X-rays?

P: No, no, they just they just put the thing on my arm. But my doctors office and said that it was high. So they said to you know, eat better and I don't I don't wanna start any drugs so, I didn't do anything. I've been fine ever since. 

D: OK, so you're not on any medications?

P: No, just yeah, no that's it. I mean I, you know sometimes take like a Tylenol if I'm
not feeling well but...

D: And do you smoke?

P: I, like I, smoke a little bit. Maybe like a pack a week.

D: A pack a week, OK? For how long?

P: Oh like since college.

D: OK OK. Um, do you smoke marijuana?

P: Uh. No, no and I I smoke, I'm trying to smoke less, you know, since they told me I have the high blood pressure. So I used to smoke a little more but this is this is less but not since I've been having trouble breathing. Is it, yeah.

D: Yeah, OK. Any other recreational drugs?

P: No no. 

D: No, OK. How about alcohol? Do you drink alcohol? 

P: Oh like, maybe you know, a beer on the weekend.

D: OK, and are you up to date with all your immunizations?

P: Like I don't I think I got all the ones when I was like a kid. What else should I have?

D: OK, so like the flu vaccine every year?

P: Oh, I get that, like my wife, my wife makes me get that. 

D: OK that's good. Any family history of lung or heart disease?

P: Oh like my, uh, my mom and dad have high blood pressure too, so I wasn't surprised when I heard that I did.

D: OK. OK. Um, OK so Rob, is there anything that you wanted to tell me that I haven't asked you already today?

P: I am really like nervous 'cause I haven't felt anything like this before. Um, like it's scary, like do you think it's like cancer or something like I don't I don't really know?

D: Um, I mean, it's hard to tell right now what it is. It sounds like it's it started pretty suddenly, um, like it started a day ago, correct?

P: Mhm.

D: Yeah, so it's unlikely that cancer would present itself like this so acutely, you know? And, but it could it could be a number of things like, it could be something like a pulmonary embolism, but you said you don't have any swelling. Um, but you did say you have some chest pain when you're breathing pretty, when you take a deep breath in. So I mean, that's a possibility. It doesn't sound like it's an infection because you don't have a fever or chills or any any other symptom really. And you mentioned there weren't any triggers like no trauma to the area. And then, other things could be like COPD because you which is a chronic obstructive pulmonary disease because you have been smoking since college and that's basically just inflammation in your lungs that causes your airways to narrow, and so you may have a hard time breathing. So for all of these things, we first start by doing some blood work and then we'll do some imaging like a chest X-ray and a pulmonary function test if indicated, and so that will give us a better idea of what you have and how we can best help you. Sounds good?

P: Yeah yeah, I just really want to get a good breath so yeah, whatever we can do.

D: Yeah for sure, and then in the meantime we'll keep monitoring you to make sure your vitals are OK and if we need to give you oxygen, we will.

P: That'd be great.

D: OK, thank you.