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Fever, pain in upper right back and difficulty in taking deep breaths. Prescribed with albuterol sulfate inhaler

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General & Family Physician
Practicing since : 2005
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My niece is a 27 year old woman she is hot to touch,has a bad pain in her upper right back and difficulty taking deep breaths
She went to doctor this morning after three days of 101 temp and got a prescription filled of albuterol sulfate inhaler every four hours, and was told to take Advil for pain. She is now trying to sleep
She also had a chest X-ray - might be a shadow high on sternum they were not sure if it was anything
Doctor's office told her to go to emergency or urgent care if she felt worse during night. What should I do?
Posted Wed, 13 Nov 2013 in Lung and Chest disorders
Answered by Dr. Prasad 43 minutes later
Brief Answer:
Prop her up and watch her symptoms...

Detailed Answer:

Lymes disease rarely causes lung complications. Therefore at the outset I do not expect lyme's to be related in this condition.

From the fact that she is running high grade fever for 3 days, it is evident that she is suffering from an infection. Posterior chest wall pain and breathing difficulty suggest perhaps the infection is from her lungs. However a good chest auscultation is absolutely necessary to confirm the severity of lung involvement.

Albuterol is prescribed to relieve broncho-constriction which is going to be essential. Shadow at the sternum may just be aortic shadow or bronchovescicular markings, that being said you should discuss it with the radiologist or chest physician and determine the nature of those shadows.

I would have also order complete hemogram along with Chest X-ray if had consulted me.

At this point of time, her symptoms seems to be stable. As the doctor suggested it is better to watch her condition and visit the ER if needed. During the night:
- Monitor her breathing and temperature (rapid breathing, worsening pain, breatlessness on rest are symptoms that recommend ER visit).
- Encourage her to sleep in a semi-recline position or in a propped up posture
- Advil can be used both to control pain and fever
- Give her warm fluids
- If she doesn't feel better in the next 2 days, I would recommend that she visits a chest physician for detailed examination. A complete hemogram and repeat chest X-ray is in order.

Hope this helps. Let me know if you need clarifications.

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