C20) Post-operative dyspnea

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with hypoxia.
  2. Review the DDx considerations in a patient with hypoxia.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating a patient with hypoxia.


Physical Exam


Provisional Diagnosis

Select the Dx you believe is most appropriate
The patient’s post-operative hypoxia is most likely secondary to atelectasis considering uncontrolled pain leading to shallow breaths and decreased breath sounds at the lung bases. The elevated white blood cell count most likely represents reactive leukocytosis following surgery.
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Potential Acuity

What is your assessment of the likely acuity for this patient?

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This patient should be evaluated to prevent respiratory decompensation.

First Imaging Study

What is the first imaging study you will order?

A chest X-ray is a good initial test to evaluate respiratory issues.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Watch our video

View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

The diagnosis is made with chest x-ray.
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What is your Diagnosis now that you have seen the imaging results?

This patient has post-operative linear atelectasis, which is a form of subsegmental atelectasis.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

Although their condition is not immediately life threatening, this patient requires management.

Assessment and Plan

Please provide your assessment and plan for this patient

This is a 65-year-old female with post-operative subsegmental atelectasis. She will require an incentive spirometer with education and frequent encouragement on its use. She should also be on a multi-modal pain regimen to ensure adequate pain control to permit adequate respiration.

Lessons Learned:
- Subsegmental atelectasis often is more likely to occur in obese patients with poor post-operative pain control who do not use incentive spirometry.
- By definition, subsegmental atelectasis includes all atelectasis forms that do not involve an entire bronchopulmonary segment. This patient has linear atelectasis, which is a form of subsegmental atelectasis.

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