A 42-Year-Old Prison Inmate Is Brought to the Emergency Department

A 42-year-old prison inmate is brought to the emergency department due to rapidly worsening shortness of breath.  He was well at breakfast an hour ago.  The patient has been seen in the emergency department several times over the last 2 years for asthma exacerbations, skin allergies, and alcohol intoxication.  He is poorly adherent to maintenance asthma medications.  Last night the patient took ibuprofen for shoulder pain that started after a physical altercation with another inmate.  He is an active smoker with a 15-pack-year history.  His last use of alcohol and cocaine was before he was incarcerated 2 months ago.  Pulse is 118/min, respirations are 30/min, and oxygen saturation is 87% on 100% oxygen via nonrebreather mask.  The patient is tall and thin, and he appears in severe respiratory distress with use of accessory muscles and subclavicular retractions.  An urticarial rash is seen over the trunk and upper extremities.  Which of the following is the most likely cause of this patient's breathing difficulty?

A) Asthma exacerbation
B) Cardiac tamponade
C) Laryngeal edema
D) Myocardial infarction
E) Pulmonary contusion
F) Tension pneumothorax

Correct Answer:

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