Case Study #1

You respond to a street corner for a teenager in respiratory distress.  You find a 16 year old male sitting on the base of a light post having obvious trouble breathing.  He is 6'2" and 105 lbs, a "beanstalk" by his own description.  You exam findings are as follows:

• Alert and Oriented to person, place time and events
• Airway is patent and self-maintaining
• Breathing is 26/bpm with intercostal retraction and tripoding.  
• Lung sounds are clear, slightly diminished on the left
• Pulses strong, regular at a rate of 108 bpm.  He is slightly pale, but otherwise unremarkable.

His history is as follows:

• S: Shortness of breath
• A: Penicillin
• M: None
• P: A "lung problem" when he was 10.  He doesn't recall what was wrong, but it's not asthma
• L: Ham and cheese sandwich about three hours ago with a coke.
• E: He was horsing around with friends, shouted at one of them, felt a pop in his chest then became short of breath.
• P: Came on as described, relieved partly with rest
• Q: "It's just hard to breathe"
• R: Slight pain at the site of the pop, but no radiation.
• S: 2/10 for the pain, 8/10 for the trouble breathing
• T: "About five minutes before they called" (Total time 15 min)
• I: "I sat down and it was a little easier to breathe"

He is placed on the stretcher, and assumes the tripod position, even after being started on 100% Oxygen. His skin becomes slightly more pink on the ride to the ER.

What is your impression of this patient?