Unexplained Hypoxemia in a Patient With Transient Ischemic Attack.

CASE PRESENTATION: An 84-year-old woman with a medical history of hypertension, hypothyroidism, and transient ischemic attacks presented with right-sided upper and lower extremity weakness for 1 day. She was a lifetime nonsmoker with no known heart disease or chronic lung disease. She had no occupational exposure or pertinent family history. She denied any fevers, chills, rashes, or shortness of breath. There was no history of recent travel.

Dyspnea in Patients with Stiff-Person Syndrome.

BACKGROUND: Stiff-person syndrome (SPS) is a rare autoimmune disorder that leads to progressively worsening stiffness and spasm of thoracic and proximal-limb musculature. Dyspnea has been reported but not analyzed in patients with SPS. MATERIALS AND METHODS: For this prospective study, 17 patients were recruited from a university-based neurology clinic. History and exam were performed, demographic information collected and available imaging reviewed. Dyspnea was assessed using vertical visual analog scales (VAS), the University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) and dyspnea "descriptors". Standardized assessments of SPS severity were performed by an experienced neurologist. Forced vital capacity (FVC) spirometric analysis was performed on all patients. RESULTS: Fifteen of 17 patients complained of dyspnea, including dyspnea at rest, with exertion, and disturbing sleep. A restrictive pattern was the most common abnormality noted on spirometry. FVC (r = -0.67; P < 0.01) and forced expiratory volume in 1-second (FEV1) (r = -0.76; P < 0.01) percent predicted correlated with dyspnea measured by VAS over the preceding 2 weeks. Pulmonary function did not correlate with UCSB-SOBQ or standardized measures of SPS severity. CONCLUSIONS: Dyspnea in SPS is common and occurs at rest with exertion and disturbs sleep. The finding of restrictive physiology and correlation between pulmonary function variables and dyspnea support the hypothesis that thoracic cage constriction by rigidity and/or spasm of the muscles of the trunk causes or contributes to the sensation of dyspnea. The possibility of diaphragmatic involvement requires further study.

Continuously recorded oxygen saturation and heart rate during prehospital transport outperform initial measurement in prediction of mortality after trauma.

INTRODUCTION: Available trauma scoring systems that predict need for higher echelons of care require data not available in the field. We hypothesized that analysis of continuous vital sign data in comparison to trauma registry data predicts mortality early in trauma patient management. METHODS: A real-time vital signs wave form and data capture system collected trauma patient data during prehospital management from Propaq 206E physiologic monitors. Analysis using statistical and mathematical software calculated receiver operator characteristic curves to evaluate the sensitivity and specificity of continuous vital sign waveforms in predicting mortality. The area under the curve (AUC) was calculated to determine nonsurvival by a particular vital sign (oxygen saturation [SpO2], heart rate, and systolic blood pressure) from these data, compared with a single value in the trauma registry, and to standard trauma scoring systems. RESULTS: The average transport time from field to hospital for all patients was 25 minutes. Eight of 120 patients (7%) died; 5 of 8 patients (62%) died within the first 24 hours. Receiver operator characteristic analysis of mean SpO2 <90% versus mortality yielded an AUC of 0.76 (p = 0.005) with a sensitivity of 62% and specificity of 86% The initial SpO2 <90% measurement from the trauma registry yielded an AUC of 0.59. Preadmission Glasgow Coma Scale score yielded an AUC of 0.74 (p = 0.009). Injury Severity Score and Trauma-Injury Severity Score produced AUCs of 0.91 and 0.96, respectively. Revised Trauma Score gave an AUC of 0.73, no different from automated predictions of mortality from SpO2. CONCLUSION: Injury Severity Score and Trauma-Injury Severity Score are predictive of mortality but rely on the inclusion of intra-abdominal and intrathoracic diagnostic data that are not readily available during field assessment. Automated vital signs data collection and analysis from a single noninvasive device with decision support has the potential to alleviate the dual burdens of patient triage and documentation required of the prehospital provider.