The 'Not Really An Asthma Attack' Case with Dr Sarah Spelsberg

In this episode of the Prehospital Care Podcast, we explore a compelling personal medical narrative by Dr Sarah Spelsberg titled “The Not Really an Asthma Attack.” The story centres on a challenging case encountered in a remote island emergency department and highlights the complexity of clinical decision-making when patients do not present in textbook fashion. Dr Spelsberg recounts the case of a 41-year-old man who arrived in severe respiratory distress, initially appearing to be suffering from a life-threatening asthma exacerbation. Standard treatment was commenced, and early investigations, including an ECG and chest X-ray, were undertaken, yet the patient failed to improve as expected.

As the clinical picture evolved, it became clear that the initial diagnosis did not fully explain the patient’s condition. Further assessment raised concern for a more serious and potentially life-threatening pathology, with features suggesting pericarditis, possibly in the context of a recent viral illness. The narrative captures the difficulty of managing a complex, non-classical presentation in a resource-limited setting, where access to specialist support is constrained, and decisions carry significant risk.

Recognising the limits of local capability and the need for specialist input, the team made the critical decision to arrange a medevac transfer to the mainland for cardiology review.

Sarah reflects on the case as a powerful reminder of diagnostic humility, the importance of reassessing assumptions when a patient’s trajectory does not fit expectations, and the professional responsibility to continue expanding one’s medical knowledge. The story resonates strongly with pre-hospital and emergency clinicians, underscoring the realities of uncertainty, vigilance, and adaptive clinical reasoning in high-stakes care. You can read the piece here: https://roguemed.medium.com/the-not-really-an-asthma-attack-c359b8370bbb