A 56-year-old woman with a history of myasthenia gravis complains of generalized fatigue and shortness of breath over the past day, without fever, chest pain, weakness, or rash. She otherwise feels well; she was treated for a urinary tract infection earlier this week, and her dysuria is much improved.
Your patient’s vital signs are: T 37.8 °C HR 110 BP 144/84 RR 26 95% RA. She is in no distress, has no obvious bulbar weakness, is able to take a reasonably deep breath on auscultation, and has a clear chest, regular heart rate, and an otherwise unremarkable examination.
Which of the following is the next most important step in her evaluation and management:
A. Early non-invasive positive-pressure ventilation (NIPPV) to avoid respiratory muscle fatigue
B. CT angiography for other possible etiologies of her shortness of breath
C. Ask her about her recent visit to her primary care physician
D. Observe her in ED, and if she continues to be stable, discharge home with close follow-up
In the meantime, a quote -- "The treatment of a disease must be entirely impersonal; the care of a patient must be completely personal." --Francis Weld Peabody (1881-1927) U.S. pathologist, hematologist, and author
Your patient’s vital signs are: T 37.8 °C HR 110 BP 144/84 RR 26 95% RA. She is in no distress, has no obvious bulbar weakness, is able to take a reasonably deep breath on auscultation, and has a clear chest, regular heart rate, and an otherwise unremarkable examination.
Which of the following is the next most important step in her evaluation and management:
A. Early non-invasive positive-pressure ventilation (NIPPV) to avoid respiratory muscle fatigue
B. CT angiography for other possible etiologies of her shortness of breath
C. Ask her about her recent visit to her primary care physician
D. Observe her in ED, and if she continues to be stable, discharge home with close follow-up
In the meantime, a quote -- "The treatment of a disease must be entirely impersonal; the care of a patient must be completely personal." --Francis Weld Peabody (1881-1927) U.S. pathologist, hematologist, and author
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