Dyspnea in a Man Who Was Stuck in a Bathroom for 24 Hours

Joshua J. Solano, MD

Disclosures

November 04, 2020

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us .

Background

An 83-year-old man was found on the bathroom floor of his apartment after he had fallen about 24 hours earlier. He reports that he had been short of breath on the day of his fall. He went to the bathroom to urinate, felt dizzy, and then "blacked out." After he struck his head on the edge of the bathtub, he was unable to get up owing to weakness. He remained on his right side, wedged between the toilet and the bathtub.

His daughter, who usually calls him daily, says that she went to his house because he had not answered the phone. She found him on the bathroom floor and called 911. Emergency medical services (EMS) providers brought him to the emergency department (ED).

The EMS providers report that his initial vital signs were an oxygen saturation of 85% on room air, a respiration rate of 28 breaths/min, a blood pressure of 185/120 mm Hg, and a heart rate of 124 beats/min. His blood glucose level was 435 mg/dL. The EMS providers found no blood at the scene.

The patient has moderate dyspnea and a headache. He denies any pain in his chest, neck, back, or extremities. He does report feeling very achy and weak. He denies any dysuria. He has missed all his medications over the past 24 hours.

His medical history includes coronary artery disease with the placement of two stents, congestive heart failure with an ejection fraction of 35%, atrial fibrillation, insulin-dependent diabetes mellitus, obesity, stage 3 chronic kidney disease, neuropathy, and hyperlipidemia. He had an appendectomy in the remote past. He has no advance directives.

His medications include carvedilol (25 mg twice daily), furosemide (40 mg twice daily), lisinopril (40 mg once daily), insulin glargine (20 units once daily), aspirin (324 mg once daily), warfarin (2.5 mg once daily), and simvastatin (20 mg once daily). He takes fish oil as a supplement.

The patient lives alone and is able to complete all activities of daily living. He denies smoking, drinking, or using illicit drugs.

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