Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea, notably orthopnea and nocturnal breathlessness. Reports significant decline in exercise tolerance and daytime fatigue. Symptoms exacerbated in the supine position, suggesting impaired diaphragmatic excursion. No history of recent trauma, neck surgery, or viral illness.
Clinical Examination Findings
General appearance: Patient appears tachypneic at rest, utilizing accessory muscles of respiration. Physical exam reveals paradoxical abdominal wall motion (inward movement during inspiration) in the supine position. Auscultation demonstrates diminished breath sounds at the lung bases. Percussion note is resonant. No evidence of jugular venous distension or lower extremity edema.
Treatment Protocol
Management plan includes: 1. Optimization of underlying etiology. 2. Initiation of nocturnal non-invasive positive pressure ventilation (NIPPV) to support alveolar ventilation. 3. Pulmonary rehabilitation to improve respiratory muscle efficiency. 4. Referral for diaphragmatic plication if symptomatic severity warrants surgical intervention. 5. Regular monitoring of arterial blood gases and pulmonary function tests (PFTs).