Differential Diagnosis for 67 y/o Female Patient

The patient presents with a complex medical history and a recent traumatic event. The differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis

  • Carbon Monoxide Poisoning and Smoke Inhalation: The patient was found in a house fire, covered in ash, with visible soot in her nares, oral cavity, and oropharynx. The combination of confusion, delirium, and the context of the house fire make carbon monoxide poisoning and smoke inhalation the most likely diagnosis. The patient's initial presentation and the need for intubation and bronchial suctioning further support this diagnosis.

• Other Likely Diagnoses

  • Acute Coronary Syndrome: Given the patient's history of CAD, recent stent placement, and elevated troponin (158), an acute coronary syndrome is a plausible diagnosis. The stress of the fire and possible hypoxia could have precipitated a cardiac event.
  • Acute Exacerbation of COPD: The patient has a history of COPD and was recently discharged after a COPD exacerbation. The smoke inhalation could have worsened her COPD, leading to an acute exacerbation.
  • Sepsis: Although the UA is negative, the patient's recent history of pneumonia and pleural effusion, along with the current presentation of confusion and elevated WBC, could suggest sepsis, especially if the pneumonia was not fully resolved.

• Do Not Miss Diagnoses

  • Pulmonary Embolism: Given the patient's history of recent thoracentesis, immobility, and the presence of Afib, pulmonary embolism is a critical diagnosis not to miss. Although less likely given the context, it could be a contributing factor to her presentation.
  • Cardiac Tamponade: The patient has a history of recent cardiac procedures and a non-functional LifeVest at the scene. Cardiac tamponade could be a life-threatening condition that needs to be ruled out, especially with the elevated troponin and BNP.
  • Hypoxia-Induced Cardiac Arrest: The patient experienced a period of no pulse and required CPR, which could be directly related to hypoxia from smoke inhalation or carbon monoxide poisoning. Ensuring adequate oxygenation and cardiac support is crucial.

• Rare Diagnoses

  • Cyanide Poisoning: Although less common, cyanide poisoning can occur in the context of fires, especially those involving plastics or other synthetic materials. The patient's presentation of confusion and cardiac arrest could be consistent with cyanide poisoning, but it is less likely without specific evidence of cyanide exposure.
  • Thyroid Storm: Given the patient's complex medical history, a thyroid storm could be a rare but possible diagnosis, especially if she has undiagnosed or poorly managed thyroid disease. However, there is no direct evidence provided in the scenario to strongly support this diagnosis.