Myasthenia Gravis Mimicking Status Asthmaticus: The Hidden Crisis

Status asthmaticus is a severe form of aggravation of asthma, whereas myasthenia gravis (MG) is a rare neuromuscular condition characterised by exhaustion and muscle weakness. Myasthenic crisis can occasionally manifest with symptoms that resemble status asthmaticus, which can result in an incorrect diagnosis and ineffective therapy. In addition to discussing the therapeutic implications, this abstract attempts to draw attention to the difficulties in distinguishing between status asthmaticus and myasthenia crisis and the importance of diagnosing subtle signs of MG. In this case, we present a 55-year-old female, with a misdiagnosed case of bronchial asthma, who presented with shortness of breath at rest for two to three days and was suspected to have an acute exacerbating episode of asthma. She was later evaluated for non-respiratory causes of dyspnea on noticing subtle signs of ptosis and was found to have an active myasthenic crisis. Although this case presented typically as status asthmaticus, it did not respond to conventional treatment of it, and on the contrary, it worsened. Hence, it is necessary to look for subtle signs of MG and promptly differentiate it from other similar emergency events to help administer accurate treatment which can prove life-saving.

Communicating With Nursing Home Residents About End of Life

Approximately 33% of the 1.2 million older individuals residing in nursing homes have the capacity to discuss their preferences for end-of-life care, and 35% will die within their first year in the nursing home. These conversations necessary to promote care consistent with the resident's preferences are often limited and most often occur when the resident is actively dying. The purpose of this secondary analysis was to understand the resident's perspectives on end-of-life communication in the nursing home and suggest approaches to facilitate this communication. We interviewed 46 participants (16 residents, 10 family members, and 20 staff) in a Southeast Florida nursing home from January to May 2019. The data were analyzed using descriptive and pattern coding and matrices to decipher preliminary categories and thematic interpretation within and across each participant group. Two themes emerged from this secondary analysis that residents assume others know their end-of-life preferences, and past experiences may predict future end-of-life choices. Residents and family members were willing to discuss end-of-life care. Study findings also suggested that past experiences with the end-of-life and critical illness of another could impact residents' and family members' end-of-life care decisions, and that nurses' recognition of subtle signs of a resident's decline may trigger provider-initiated end-of-life conversations. Future research should focus on strategies to promote earlier end-of-life discussions to support independent decision-making about end-of-life care in this relatively dependent population of older adults.