Pneumonia: Shortness of Breath in a Young College Student

As a practicing internal medicine physician working in the ICU, I am writing several articles based on my real life experience taking care of patients with pneumonia. As I stated in my other article, the signs, symptoms and diagnosis of pneumonia depends on the unique characteristics of the patient. In this article, I will be describing about a young college student who was very sick when I took care of her. I have changed some details to make the patient unidentifiable but the case is real.

Miss Y is a twenty two year old college student who was returning home for the holidays. She had not been feeling well for the past three days but she just thought she had the flu. Her symptoms started with some cold chills but she just blamed it on the weather and dismissed it. After all, it was the third week of December. She felt a little dizzy when she was standing in line at the airport as she was waiting to board the flight home. She had to sit down for a while before she felt strong enough to stand in line again to board the plane. In the flight, she felt a little nauseated and felt as if she was not getting enough air. She did not feel any better even after she went home with her mom and sat in the kitchen chair with a cup of hot chocolate. She actually threw up the hot chocolate and was even weaker afterwards. She noticed she was not getting enough air and wanted to open the windows to let fresh air in. At that point the mother was really concerned and drove her to the local emergency department.

She looked very sick when she arrived. The ER nurse checked her oxygen saturation and it was critically low. She was breathing very fast and her blood pressure was going down. They activated the emergency response team, talked to the mother and decided to intubate her to protect her breathing. They had to put a tube down her mouth, into her airway (trachea) and had to hook it up to a machine that forced high flow oxygen into her lungs to be able to get her oxygen saturation up to a safe level. After she was a little more stable, they took her down to the radiology and performed a CAT scan of her chest.

As the on call doctor, I was then called to admit the patient. They send her directly to the ICU after the CAT scan. I looked at the scanned image in the ICU computer. I could see the dense gunky material that seemed to occupy the whole lower part of the right lung. She had a bad pneumonia. The rest of her lungs seemed to be under severe distress and appeared swollen.

I talked to the mother about her condition and explained that her condition was critical. I asked her if she had any kind of illness or other health problems in the past. The mother told me that when she was 9, she had some kind of blood problem and doctors found an enlarged spleen. They had to do a surgery to take her spleen out. Her blood problem was solved after the surgery and she had not been seriously ill since then.

That explained a lot about why she was so sick and how it happened so fast. She did not have a spleen. Spleen is an organ that normally sits in the left side of the abdomen next to the stomach. Among many other functions, it works as a blood filter. It helps to protect against certain bacteria by helping to kill them. One group of such bacteria is the one that can cause a common type of pneumonia. The medical name of that particular type of bacteria is Pneumococcus. In medical terms what she had could be described as a case of severe Pneumococcal Pneumonia leading to Acute Respiratory Distress syndrome (ARDS) requiring mechanical ventilation in a patient with a history of splenectomy. I hope that the story of my patent will help you understand what that means without having to explain each medical term. You can read more about ARDS in the US National Library of Medicine here. Here is an article about Pneumococcus in e-medicine. Mayo clinic staff describes the details of splenectomy (surgical removal of spleen) here.

Our patient remained hooked up to the breathing machine for the next 4 days. She was treated with antibiotics and high pressured oxygen. As she improved, we gradually decreased the oxygen pressure. Her lung function improved and we slowly weaned her off of the machine. When she was strong enough to breathe on her own, we took the tube out. She still needed some supplemental oxygen and remained in the hospital for three more days. In the end, her holidays were ruined but she still had a few days to rest and recover at home before heading back to the college. I hope that my patient centered approach provides some fresh human angle to a normally impersonal approach to describing diseases and conditions. I would gladly welcome any questions or comments from the reader.

Related article from Dr. Sapkota:

Pneumonia: An elderly female in a nursing home

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