Discuss and practice the components of the respiratory history and physical examination. Practice an approach to the environmental exposure history using the CH2 OPD2 format. Pro-Comp Connection – Health Effects of Climate Change: : Climate change presents a fundamental threat to human health, with the potential to undermine and reverse decades of health progress. Increasingly frequent disruptions caused by climate change may overwhelm the efforts of the healthcare system to address social determinants of health, if those latter efforts ignore the changing environment. Climate change impacts health both directly and indirectly and is strongly mediated by structural determinants of health.

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

Discuss and practice the components of the respiratory history and physical examination. Practice an approach to the environmental exposure history using the CH2 OPD2 format. Pro-Comp Connection – Health Effects of Climate Change: : Climate change presents a fundamental threat to human health, with the potential to undermine and reverse decades of health progress. Increasingly frequent disruptions caused by climate change may overwhelm the efforts of the healthcare system to address social determinants of health, if those latter efforts ignore the changing environment. Climate change impacts health both directly and indirectly and is strongly mediated by structural determinants of health.

What are Pulmonary Function Tests? Noninvasive measure of lung volume, capacity, flow rates and gas exchange.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

A youth is brought into the emergency department by paramedics after being found unconscious lying on a sewer grate. No further history is available. In the triage unit, the patient’s respiratory rate is 8 breaths per minute, and breaths are shallow. Heart rate is 50 beats per minute. Oxygen saturation by pulse oximetry is 90% on room air. Pupils are constricted and fixed. “Track marks” are noted on the forearms. The triage nurse applies oxygen by mask and the emergency resident orders a medication given through an intravenous line. Three minutes later the patient is awake, agitated, and complaining of severe generalized pain. Respiratory rate is 30 breaths per minute. When the medicine resident arrives at the bedside an hour later to admit the patient, the youth is once more unconscious, breathing slowly and shallowly as on arrival in triage.

Teresa, a 65-year-old woman, is brought to the emergency room by a friend who was unable to arouse Teresa completely. Her friend reports that Teresa had been unwell for three days with persistent vomiting. In the emergency room, Teresa is only semi-rousable. Her pulse is 130 and blood pressure is 100/70. Her breathing is rapid and deep. Teresa’s medical record indicates a history of poorly controlled diabetes and premature coronary artery disease, with a prior myocardial infarction at age 49. She is described as “treatment non-compliant” and is noted to have a “difficult psychosocial situation”.

Sarah Rosenthal, a 63-year-old woman, has been a smoker for many years and has noticed a gradual reduction in her exercise tolerance over the last three years, finding it more difficult to garden and to walk to her synagogue. She has been able to modify her activities in response to the limitations imposed by her breathlessness but her family has noted her weight has been increasing. When her family noticed that her legs were becoming more swollen and that she was not as "sharp" as usual, they decided to bring her to the emergency room. Her family reports that Sarah has recently visited her family physician and was prescribed a diuretic for her ankle swelling.

A youth is brought into the emergency department by paramedics after being found unconscious lying on a sewer grate. No further history is available. In the triage unit, the patient’s respiratory rate is 8 breaths per minute, and breaths are shallow. Heart rate is 50 beats per minute. Oxygen saturation by pulse oximetry is 90% on room air. Pupils are constricted and fixed. “Track marks” are noted on the forearms. The triage nurse applies oxygen by mask and the emergency resident orders a medication given through an intravenous line. Three minutes later the patient is awake, agitated, and complaining of severe generalized pain. Respiratory rate is 30 breaths per minute. When the medicine resident arrives at the bedside an hour later to admit the patient, the youth is once more unconscious, breathing slowly and shallowly as on arrival in triage.

Sarah Rosenthal, a 63-year-old woman, has been a smoker for many years and has noticed a gradual reduction in her exercise tolerance over the last three years, finding it more difficult to garden and to walk to her synagogue. She has been able to modify her activities in response to the limitations imposed by her breathlessness but her family has noted her weight has been increasing. When her family noticed that her legs were becoming more swollen and that she was not as "sharp" as usual, they decided to bring her to the emergency room. Her family reports that Sarah has recently visited her family physician and was prescribed a diuretic for her ankle swelling.

Rana Osman is a 2-year-old girl who has been previously well. She has had a barky, seal-like cough for 2 days but tonight has become acutely worse. In the emergency room, she is found to be sitting "bolt upright", with pronounced stridor on inspiration. Her inspiratory phase is prolonged. She has intercostal indrawing and suprasternal indrawing.

Ron Chen is a 25 year old computer sciences post-graduate student who had been previously well. Three weeks ago he suffered a viral gastroenteritis from which he has recovered. Over the past week, he has noticed increasing weakness of his limbs, starting with his legs, and progressing to involve his arms. He reports he has experienced patchy areas of sensory loss, symmetrically. He has also noticed occasional clumsy speech and facial weakness.

A youth is brought into the emergency department by paramedics after being found unconscious lying on a sewer grate. No further history is available. In the triage unit, the patient’s respiratory rate is 8 breaths per minute, and breaths are shallow. Heart rate is 50 beats per minute. Oxygen saturation by pulse oximetry is 90% on room air. Pupils are constricted and fixed. “Track marks” are noted on the forearms. The triage nurse applies oxygen by mask and the emergency resident orders a medication given through an intravenous line. Three minutes later the patient is awake, agitated, and complaining of severe generalized pain. Respiratory rate is 30 breaths per minute. When the medicine resident arrives at the bedside an hour later to admit the patient, the youth is once more unconscious, breathing slowly and shallowly as on arrival in triage.

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Ron Chen is a 25 year old computer sciences post-graduate student who had been previously well. Three weeks ago he suffered a viral gastroenteritis from which he has recovered. Over the past week, he has noticed increasing weakness of his limbs, starting with his legs, and progressing to involve his arms. He reports he has experienced patchy areas of sensory loss, symmetrically. He has also noticed occasional clumsy speech and facial weakness.

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Ron Chen is a 25 year old computer sciences post-graduate student who had been previously well. Three weeks ago he suffered a viral gastroenteritis from which he has recovered. Over the past week, he has noticed increasing weakness of his limbs, starting with his legs, and progressing to involve his arms. He reports he has experienced patchy areas of sensory loss, symmetrically. He has also noticed occasional clumsy speech and facial weakness.

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

Ron Chen is a 25 year old computer sciences post-graduate student who had been previously well. Three weeks ago he suffered a viral gastroenteritis from which he has recovered. Over the past week, he has noticed increasing weakness of his limbs, starting with his legs, and progressing to involve his arms. He reports he has experienced patchy areas of sensory loss, symmetrically. He has also noticed occasional clumsy speech and facial weakness.

Ron Chen is a 25 year old computer sciences post-graduate student who had been previously well. Three weeks ago he suffered a viral gastroenteritis from which he has recovered. Over the past week, he has noticed increasing weakness of his limbs, starting with his legs, and progressing to involve his arms. He reports he has experienced patchy areas of sensory loss, symmetrically. He has also noticed occasional clumsy speech and facial weakness.

Edwin is a 4-year-old boy enjoying a day at the Caledonia Fall Fair. He is walking around, enjoying the sights while eating a hot dog, when he suddenly begins to choke. Bystanders look on, horrified. An alert medical student, who happens to be taking a break from studying, is on the scene. She rushes over, comes up behind Edwin and administers an abdominal thrust. The piece of hot dog is expelled from Edwin, and he takes a big breath.He is fine, the medical student is relieved and congratulations are offered all around at this happy ending. In speaking with Edwin’s parents after the incident, the medical student notices a colorful circular pin on his mother’s jacket. The medical student inquires about the pin, and Edwin’s mother states the pin represents the Medicine Wheel, an important concept for their family’s health.

Rana Osman is a 2-year-old girl who has been previously well. She has had a barky, seal-like cough for 2 days but tonight has become acutely worse. In the emergency room, she is found to be sitting "bolt upright", with pronounced stridor on inspiration. Her inspiratory phase is prolonged. She has intercostal indrawing and suprasternal indrawing.

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

Edwin is a 4-year-old boy enjoying a day at the Caledonia Fall Fair. He is walking around, enjoying the sights while eating a hot dog, when he suddenly begins to choke. Bystanders look on, horrified. An alert medical student, who happens to be taking a break from studying, is on the scene. She rushes over, comes up behind Edwin and administers an abdominal thrust. The piece of hot dog is expelled from Edwin, and he takes a big breath.He is fine, the medical student is relieved and congratulations are offered all around at this happy ending. In speaking with Edwin’s parents after the incident, the medical student notices a colorful circular pin on his mother’s jacket. The medical student inquires about the pin, and Edwin’s mother states the pin represents the Medicine Wheel, an important concept for their family’s health.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Rana Osman is a 2-year-old girl who has been previously well. She has had a barky, seal-like cough for 2 days but tonight has become acutely worse. In the emergency room, she is found to be sitting "bolt upright", with pronounced stridor on inspiration. Her inspiratory phase is prolonged. She has intercostal indrawing and suprasternal indrawing.

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

Edwin is a 4-year-old boy enjoying a day at the Caledonia Fall Fair. He is walking around, enjoying the sights while eating a hot dog, when he suddenly begins to choke. Bystanders look on, horrified. An alert medical student, who happens to be taking a break from studying, is on the scene. She rushes over, comes up behind Edwin and administers an abdominal thrust. The piece of hot dog is expelled from Edwin, and he takes a big breath.He is fine, the medical student is relieved and congratulations are offered all around at this happy ending. In speaking with Edwin’s parents after the incident, the medical student notices a colorful circular pin on his mother’s jacket. The medical student inquires about the pin, and Edwin’s mother states the pin represents the Medicine Wheel, an important concept for their family’s health.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Rana Osman is a 2-year-old girl who has been previously well. She has had a barky, seal-like cough for 2 days but tonight has become acutely worse. In the emergency room, she is found to be sitting "bolt upright", with pronounced stridor on inspiration. Her inspiratory phase is prolonged. She has intercostal indrawing and suprasternal indrawing.

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

Edwin is a 4-year-old boy enjoying a day at the Caledonia Fall Fair. He is walking around, enjoying the sights while eating a hot dog, when he suddenly begins to choke. Bystanders look on, horrified. An alert medical student, who happens to be taking a break from studying, is on the scene. She rushes over, comes up behind Edwin and administers an abdominal thrust. The piece of hot dog is expelled from Edwin, and he takes a big breath.He is fine, the medical student is relieved and congratulations are offered all around at this happy ending. In speaking with Edwin’s parents after the incident, the medical student notices a colorful circular pin on his mother’s jacket. The medical student inquires about the pin, and Edwin’s mother states the pin represents the Medicine Wheel, an important concept for their family’s health.

Luke, a 47 year old gentleman with a history of chronic alcoholism and poor eating habits, goes to the ER with a complaint of chest pain. He smokes two packs of cigarettes daily. He has not been feeling well for over one week due to an upper respiratory infection. Two days ago he developed a fever, chills and a sharp pain over his right chest that is worse when he breathes in. Luke had a dry cough initially, but today he has coughed up rusty sputum with some blood in it. Although Luke is not normally short of breath, he has had difficulty climbing the stairs to the office because of breathlessness.

Salim takes Nabil, his 7-year-old son, to see Dr. Lockwood, his family doctor, because both of them have a sore throat. Nabil’s younger brother had a sore throat and runny nose a week ago, but he improved quickly. Salim is concerned about Nabil because he seems to be taking longer to improve. Dr. Lockwood asks more details and learns that both Nabil and Salim are mostly having swallowing difficulties but feel otherwise quite well. Salim has a mild cough, but Nabil does not. There have been no rigors, just slight chills last night.

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

Luke, a 47 year old gentleman with a history of chronic alcoholism and poor eating habits, goes to the ER with a complaint of chest pain. He smokes two packs of cigarettes daily. He has not been feeling well for over one week due to an upper respiratory infection. Two days ago he developed a fever, chills and a sharp pain over his right chest that is worse when he breathes in. Luke had a dry cough initially, but today he has coughed up rusty sputum with some blood in it. Although Luke is not normally short of breath, he has had difficulty climbing the stairs to the office because of breathlessness.

Luke, a 47 year old gentleman with a history of chronic alcoholism and poor eating habits, goes to the ER with a complaint of chest pain. He smokes two packs of cigarettes daily. He has not been feeling well for over one week due to an upper respiratory infection. Two days ago he developed a fever, chills and a sharp pain over his right chest that is worse when he breathes in. Luke had a dry cough initially, but today he has coughed up rusty sputum with some blood in it. Although Luke is not normally short of breath, he has had difficulty climbing the stairs to the office because of breathlessness.

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Teresa, a 65-year-old woman, is brought to the emergency room by a friend who was unable to arouse Teresa completely. Her friend reports that Teresa had been unwell for three days with persistent vomiting. In the emergency room, Teresa is only semi-rousable. Her pulse is 130 and blood pressure is 100/70. Her breathing is rapid and deep. Teresa’s medical record indicates a history of poorly controlled diabetes and premature coronary artery disease, with a prior myocardial infarction at age 49. She is described as “treatment non-compliant” and is noted to have a “difficult psychosocial situation”.

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Teresa, a 65-year-old woman, is brought to the emergency room by a friend who was unable to arouse Teresa completely. Her friend reports that Teresa had been unwell for three days with persistent vomiting. In the emergency room, Teresa is only semi-rousable. Her pulse is 130 and blood pressure is 100/70. Her breathing is rapid and deep. Teresa’s medical record indicates a history of poorly controlled diabetes and premature coronary artery disease, with a prior myocardial infarction at age 49. She is described as “treatment non-compliant” and is noted to have a “difficult psychosocial situation”.

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

A 55 year-old lady is reviewed in the Respirology clinic because she has become increasingly breathless and can no longer keep up with her friends when walking. The referral letter notes that she has no history of heart disease. She denies any cough, wheezing, or chest pain. She does say that she spends a lot of her time lying down in bed because this eases her breathlessness.

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

Teresa, a 65-year-old woman, is brought to the emergency room by a friend who was unable to arouse Teresa completely. Her friend reports that Teresa had been unwell for three days with persistent vomiting. In the emergency room, Teresa is only semi-rousable. Her pulse is 130 and blood pressure is 100/70. Her breathing is rapid and deep. Teresa’s medical record indicates a history of poorly controlled diabetes and premature coronary artery disease, with a prior myocardial infarction at age 49. She is described as “treatment non-compliant” and is noted to have a “difficult psychosocial situation”.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.

Control of breathing. Chest wall, diaphragm. The airway.