Telephone triage with orthopnea and a stopped yellow medicine
At 02:15 you take a triage call. A 68-year-old woman speaks quickly in a mixed Sofia–Pleven dialect. You catch: 'От вчера не мога да дишам, пия си хапчетата, но краката ми са подути, а тази нощ се събудих три пъти.' She denies chest pain but says she has a 'тежест' when lying flat and slept on three pillows. She mentions 'сърцебиене' and that her GP prescribed 'едни жълти хапчета' last month, but she stopped them because they made her cough. She lives alone; her daughter is 40 minutes away. The line is noisy and she becomes breathless while speaking. You have no prior record.
1. Write three Bulgarian questions you would ask next to separate a cardiac cause from a respiratory cause. Explain what answer would change your urgency.
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- 'Кога започна задухът - внезапно или постепенно, и има ли го и когато сте в покой?' Why: breathlessness at rest or sudden onset raises urgency; gradual exertional breathlessness is less immediately alarming.
- 'Може ли да лежите легнала, или ви трябват повече възглавници? Събуждате ли се със задух?' Why: orthopnea and paroxysmal nocturnal dyspnea point toward heart failure rather than simple bronchitis.
- 'Имате ли температура, храчки, хрипове или болка в гърдите при дишане?' Why: fever, purulent sputum and pleuritic pain point toward infection or another respiratory cause. Also ask: 'Можете ли да ми покажете кутията на жълтите хапчета?' because the cough may be an ACE-inhibitor effect, but you must not guess the drug.
2. Given the information you already have, what disposition do you choose and what exact Bulgarian sentence do you say to her? Justify both.
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Disposition: immediate emergency ambulance or urgent home visit, not a routine GP appointment. Reasons: she is breathless while speaking, has 'тежест' when lying flat, slept on three pillows, reports bilateral leg swelling, stopped an unknown medicine, and lives alone. Sentence: 'Госпожо, имате признаци, които изискват спешен преглед още сега. Ще извикам линейка и ще остана на телефона с Вас, докато дойде. Седнете, както Ви е по-леко, и не приемайте нови лекарства.' Reasoning: the sentence is short, says 'сега', avoids giving a diagnosis such as 'сърдечна недостатъчност', gives one safe posture instruction, and does not tell her to take an unknown 'жълто хапче'. Staying on the line addresses the living-alone risk.
3. Write a one-line Bulgarian triage note that separates confirmed facts from her own words and flags the medication uncertainty.
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Note: '68 г. жена, сама, обаждане в 02:15: по думите ѝ - задух от вчера, тежест при лягане, три събуждания през нощта, оток на краката, сърцебиене; спряла „жълти хапчета“ заради кашлица (възможно АСЕ-инхибитор - неуточнено); линейка извикана.' Reasoning: 'по думите ѝ' marks subjective report; 'неуточнено' prevents the note from turning a guess into a fact; the time and living-alone status are included because they affect disposition.