Medical Emergencies · patient case question
How should the appointment itself be modified?
Patient case: Two medical histories, one year apart
Patient: 66-year-old man returning after a year away.
Chief complaint: I want to start taking care of my mouth.
History: Last year's history: hypertension on medication, and shortness of breath when lying flat that improves when he sits up. This year's history adds a myocardial infarction thirteen months ago, now managed with dual antiplatelet therapy and a statin.
Findings: BP 142/88. Generalized plaque, several carious lesions, and moderate periodontitis. He becomes uncomfortable when the chair is reclined.
Show answer and explanation
Correct answer: D. Treat him in an upright or semi-supine position
- A. Full supine positioning is precisely what provokes his symptoms, by increasing venous return and pulmonary congestion.
- B. Trendelenburg is a management position for syncope, not a treatment position, and would be intolerable here.
- C. A patient who cannot lie flat and has had a recent infarction needs both positional and scheduling modifications.
- D. CORRECT. ORTHOPNEA — breathlessness that comes on lying flat and eases on sitting up — means he cannot tolerate a supine chair. Treat him upright or semi-supine, keep appointments short, schedule them for the morning, and monitor him.
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