Sats in the 60s

Abstract

A 61-year-old man presented to the emergency department (ED) with sudden onset shortness of breath, coughing paroxysms, and a brief loss of consciousness. The emergency medical services (EMS) noted the patient to be diaphoretic and unresponsive, with a prior history of single lung transplantation. His current medications were multiple, without known allergy. Upon ED arrival, the patient was alert and oriented with normal vital signs, except for a marked tachypnea and saturations of 64% on 100% oxygen via a non-rebreather face mask. The initial chest radiograph shows a density in the left upper lung field, missed on the radiologist’s reading of the film (Fig. ​(Fig.1a,1a, arrow). Shortly thereafter, the patient began to cough violently and expelled a large pellet of chalk-like material, ascertained to be the remnants of a calcium supplement. Post expulsion, the oxygen saturation immediately rose to 99% and his respiratory rate decreased to 14. A repeat chest radiograph revealed an absence of the calcified density in the left upper lobe, and clear reduction of adjacent parenchymal atelectasis (Fig. ​(Fig.1b).1b). Clinicians should consider the possibility of pill aspiration on the differential for sudden marked hypoxia and tachypnea, especially in post lung transplant patients. Fig. 1 a Initial and b repeat chest radiographs