I actually like this article too and find it interesting. As s neurologist I have very similar sentiments to the word/ symptom: "dizzy." What does that mean? Light headed? Vertiginous? Ataxic? Off balance? Unsteady? And each of these can implicate different causes: inner ear. Stroke, brain stem, cerebellar, orthostatic hypotension, neuropathy etc.
Timely publish. I was just in a conversation with a doctor. I described my patient's breathing as tachy, like a panting dog. He, who had not seen the patient, stated it was wheezing. Lung sounds were clear. I was having a difficult time in describing it and finding the cause. Then was reminded about the 'mass' (had not been biopsied) in R lobe. The "panting" was trying to move more O2 throughout the body because the mass was preventing full inspiration. There is a scale for everything: Morse Fall, FLACC, PAINAD, Nutrition, PPS, FAST, Mortality, etc. There should be a means to rank, rate, and describe breathing.
I'm an acupuncturist and I too tell people that saying "low back pain" to me is like saying "snow" to an Inuit. But the differentiation here is much easier than with breathlessness - where exactly is the pain? Describe the onset? Chronic or recent? What activity makes it hurt and what gives relief? Do you find yourself leaning forward and putting weight on your shopping cart in a grocery store? But the breathlessness question interests me because I have both asthma and mitral stenosis - I know that the asthma causes SOB but have absolutely no way of knowing if or how much the stenosis contributes.
Not sure why the authors omitted inquiring about orthopnea and paroxysmal nocturnal dyspnea - reasonably good pointers to a cardiac etiology of shortness of breath. (Someone has likely studies sensitivity, specificity of these Oslerian clinical signs. Regardless, they work pretty well in clinical practice)
As per usual, Dr. Cifu’s article is enlightening, thought-provoking, and insightful.
Although my comment is not directly related to the content of the article, there is one pearl that has served me well in differentiating “shortness of breath“ in emergency situations.
The tachypnea of hyperventilation versus acidosis: In hyperventilation, the stimulus is neurobiological, and the emphasis is virtually always on inspiration. In the acidotic patient the emphasis is on expiration in an attempt to blow off as much CO2 as possible in an attempt to correct the acidosis. The diagnosis of DKA in the diabetic patient can often be made at the bedside, even before the glucose and pH is determined.
I actually like this article too and find it interesting. As s neurologist I have very similar sentiments to the word/ symptom: "dizzy." What does that mean? Light headed? Vertiginous? Ataxic? Off balance? Unsteady? And each of these can implicate different causes: inner ear. Stroke, brain stem, cerebellar, orthostatic hypotension, neuropathy etc.
Who wants to help fund this paper?!! Seriously!
Timely publish. I was just in a conversation with a doctor. I described my patient's breathing as tachy, like a panting dog. He, who had not seen the patient, stated it was wheezing. Lung sounds were clear. I was having a difficult time in describing it and finding the cause. Then was reminded about the 'mass' (had not been biopsied) in R lobe. The "panting" was trying to move more O2 throughout the body because the mass was preventing full inspiration. There is a scale for everything: Morse Fall, FLACC, PAINAD, Nutrition, PPS, FAST, Mortality, etc. There should be a means to rank, rate, and describe breathing.
I'm an acupuncturist and I too tell people that saying "low back pain" to me is like saying "snow" to an Inuit. But the differentiation here is much easier than with breathlessness - where exactly is the pain? Describe the onset? Chronic or recent? What activity makes it hurt and what gives relief? Do you find yourself leaning forward and putting weight on your shopping cart in a grocery store? But the breathlessness question interests me because I have both asthma and mitral stenosis - I know that the asthma causes SOB but have absolutely no way of knowing if or how much the stenosis contributes.
Not sure why the authors omitted inquiring about orthopnea and paroxysmal nocturnal dyspnea - reasonably good pointers to a cardiac etiology of shortness of breath. (Someone has likely studies sensitivity, specificity of these Oslerian clinical signs. Regardless, they work pretty well in clinical practice)
I think they did not consider those descriptors of dyspnea but rather things to be found in the PQRST questioning.
I only have asthma and when I’m in a crisis (very rare) ALL of it is snow - I mean all symptoms point to “YES”
I think I’d get myself into too much trouble joking about the “shortness of breast” typo so I’ll just say thanks for a great post! : )
Fixed! Thanks.
Saw that!
As per usual, Dr. Cifu’s article is enlightening, thought-provoking, and insightful.
Although my comment is not directly related to the content of the article, there is one pearl that has served me well in differentiating “shortness of breath“ in emergency situations.
The tachypnea of hyperventilation versus acidosis: In hyperventilation, the stimulus is neurobiological, and the emphasis is virtually always on inspiration. In the acidotic patient the emphasis is on expiration in an attempt to blow off as much CO2 as possible in an attempt to correct the acidosis. The diagnosis of DKA in the diabetic patient can often be made at the bedside, even before the glucose and pH is determined.
Ben Hourani MD