I have been asked by many to start including actual case studies from my personal hospital experience. I will limit these cases to those that just involve patients who had smoking related diseases, although, I may venture off every once in a while to talk about very unusual to interesting cases. I may even ask questions to see if you can figure out what may have happened to the patient.
Here's a quick case study off the top of my mind. We had a 58 y/o white male present with shortness of breath. His lung sounds included lots of crackles and wheezing, with a prolonged expiratory phase. His respiratory rate was > 25. He quit smoking 1 year prior to this admission, but had smoked 1 - 1.5 packs of cigarettes per day for 40 years. He had spiked a temperature at 101.4 F the night before. His ankles had 1+ edema (swelling). He had a history of 2 previous heart attacks (AMI). He was not a candidate for heart surgery, due to his poor baseline respiratory status. He was diagnosed with Stage 4 emphysema and was dependent on a multiple of inhalers, as well as, continuous nocturnal bipap.
This gentleman was the nicest guy around. We loved seeing him in the hospital but were sad because we only saw him as a patient, rather than a visitor. He is what you call a "frequent flyer". In other words, he found himself in our ER frequently throughout the year with the same old symptoms. His hospital stays would typically last about 10 days. His diagnosis was always the same:
1) COPD (emphysema)
2) Community acquired pneumonia
3) Congetive heart failure
4) Ischemic heart disease
5) Hypertension (high blood pressure)
6) Acute respiratory failure
7) Chronic respiratory failure
Here is an example of someone's body not tolerating the effects of a 40 pack year smoking history very well. I could also give you an example of someone who smoked just as much, but didn't have nearly the physiological devastation that this man had.
But the point is, you never know how your body will respond over time to the smoking. Which person will you turn into? Patient A who needed a machine at night to ensure he didn't stop breathing when he was asleep and continuous oxygen the rest of the time, or the other patient whose body faired a little better?
Hard core smokers are quick to point out lots of patient B examples, and tend to ignore or even deny the existence of the over couple hundred thousand patients a year that die due to smoking related illnesses. It's important to drive home the realism of smoking related disease, as often times, this is the only thing people will listen to.
I hope to share even more real life case studies in the future to offset the hum-drum nature of literature review.
