FHIR R4 Symptoms Implementation Guide, published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-symptoms-ig/ and changes regularly. See the Directory of published versions

Use Cases

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Chest Pain and Shortness of Breath

Jane Doe, a 60-year-old English-speaking Latina woman with a history of type 2 diabetes mellitus and hypertension, presented to the emergency department (ED) for evaluation of shortness of breath. When speaking to the ED triage nurse, she described her symptoms by saying: “For the last six weeks, I have been getting so winded when I have been walking upstairs.” The ED nurse documented a chief complaint of shortness of breath and mentioned in the ED triage note that the shortness of breath occurred upon exertion and resolved with rest. The patient’s vital signs were documented in triage as blood pressure 162/90, respiratory rate 18, pulse 84, oxygen saturation 97% on room air, and temperature 98.2 degrees Fahrenheit.

One hour later, the ED physician assessed the patient. At that time, the patient reported no current shortness of breath. She described intermittent shortness of breath that occurred with exertion and was relieved with rest. The most recent episode was yesterday. At that time, she ran up a flight of stairs as she was chasing her 5-year-old son. When she reached the top of the stairs, she was profoundly short of breath. The shortness of breath lasted approximately 5 minutes, and then it resolved. For the first time ever, she experienced chest pain in addition to the shortness of breath. The chest pain lasted 20 minutes and then resolved, too. Because this was the first ever episode of chest pain, she decided to seek emergency care. The chest pain was described as crushing or “like an elephant sitting on my chest”. There was no radiation of the pain. Concurrently with the shortness of breath and chest pain, she experienced dizziness and light-headedness. In terms of other associated symptoms, she denied fever or chills. There was no cough. While she felt light-headed, she did not pass out.

Dizziness

Mr. John Doe is a 72-year-old male who presents to the office with a complaint of dizziness that has been progressively worsening over the past 3 weeks. He describes the dizziness as a sensation of light-headedness and feeling as though the room is spinning, particularly when he stands up or changes positions. He reports experiencing the dizziness several times throughout the day, especially after standing up from a seated position or when walking across the room. He denies any episodes of fainting or losing consciousness.

The dizziness typically lasts for a few seconds to a minute and tends to resolve after he remains still or sits down. He has not experienced any significant headaches, chest pain, or shortness of breath associated with these episodes. He denies any recent falls but has noticed occasional unsteadiness while walking.

The patient also mentions mild hearing loss in his right ear for the past few months, though it has not been bothersome until recently. He denies any ringing in the ears (tinnitus) or ear fullness. He does not have any visual changes, such as double vision or blurred vision, and he has not experienced any nausea or vomiting with the dizziness.

He reports that his symptoms have not improved with increased fluid intake or rest, and he is concerned about the worsening of his dizziness. He also notes a slight decrease in his ability to perform his usual daily activities, though he is still able to walk short distances and complete light household chores.

Past medical history is significant for hypertension, hyperlipidemia, and osteoarthritis. He takes lisinopril and atorvastatin daily. He has no known history of stroke, diabetes, or cardiovascular disease. He does not smoke and drinks alcohol only occasionally. Family history is significant for hypertension and coronary artery disease in his father.

He has not had any recent viral infections, trauma, or changes in medication that he can recall.

Public Health

Trish Doe, a 45-year-old female, previously healthy, presents to the emergency department with a three-day history of worsening cough, shortness of breath, and high fever (102.5°F). She reports generalized myalgia, fatigue, and chills. Her symptoms began as mild nasal congestion and sore throat but rapidly progressed to respiratory distress. She denies any known sick contacts but had recently traveled internationally. On examination, she appears ill and mildly diaphoretic. Her respiratory rate is 26 breaths per minute, and oxygen saturation is 89% on room air. Auscultation reveals diffuse bilateral crackles without wheezing. A chest X-ray demonstrates patchy ground-glass opacities. Influenza PCR testing identifies a novel strain of influenza A. Given the rapid progression, there is concern for viral pneumonia and acute respiratory distress syndrome (ARDS).The patient is admitted for supportive care, including oxygen therapy, antiviral treatment with neuraminidase inhibitors, and close monitoring for signs of respiratory failure. Given the patient's worsening respiratory distress and concerning oxygen saturation, the emergency department physician orders further radiological evaluation. A CT scan of the chest reveals diffuse bilateral ground-glass opacities and areas of consolidation. No signs of bacterial superinfection are noted, but the severity of lung involvement prompts immediate escalation of care.

The patient is transferred to the intensive care unit (ICU) for closer monitoring and potential need for advanced respiratory support. Upon arrival, her respiratory status deteriorates further, with increased work of breathing and persistent hypoxia despite supplemental oxygen. The decision is made to initiate high-flow nasal cannula therapy, and was planned for mechanical ventilation, should her condition fail to improve. A multi-disciplinary team, including infectious disease specialists and pulmonary critical care providers, collaborates on management. Empirical antiviral therapy with a neuraminidase inhibitor is continued, and broad-spectrum antibiotics are considered to cover for potential secondary bacterial infections. Close monitoring for cytokine storm and multi-organ involvement is underway, as novel strains of influenza have been known to trigger systemic complications. Over the next 48 hours, her condition remains guarded, with fluctuating oxygen demands and evolving laboratory markers indicative of systemic inflammation. The ICU team remains on high alert, ready to intervene as necessary