Life with Myasthenia Gravis Myasthenia Gravis Survival Guide
Nutrition and Myasthenia Gravis Safety and Myasthenia Gravis
Myasthenia Gravis the ACh Receptor Emergency management of Myasthenia Gravis
Emergency Management of Myasthenia Gravis
Medical emergencies ("crisis") are rare but may occur when the muscles that support respirations are so weak that breathing becomes very difficult. Respirations may be shallow and ineffective. The airway may become obstructed due to weakened throat muscles and accumulated secretions.
Due to facial muscle weakness, a slurred speech pattern and/or an inability to respond normally, an individual who is severely weakened by MG may appear to be intoxicated. Carrying an MG Identification Card will help others to identify the cause of weakness quickly.
FAILURE TO TREAT SYMPTOMS PROMPTLY CAN RESULT IN POOR AIR EXCHANGE AND RESPIRATORY INSUFFICIENCY OR ARREST. SEEK MEDICAL CARE EARLY TO PREVENT EMERGENCIES. MAINTAIN AN OPEN AIRWAY
SUPPORT AIR EXCHANGE.
Severe Respiratory Difficulty
Subjective findings may include shortness of breath at rest, air hunger, inability to lay flat, anxiety, restlessness, fatigue.
Evaluate
airway patency
strength of cough
respiratory rate & effort
cardiac status skin & nailbed color and temperature
mental status
Physical examination may reveal skin & nailbed color changes (pale to cyanotic), cool and moist skin, weak cough, rapid heart rate, increased blood pressure, rapid or shallow respirations, confusion, lethargy.
First Responder Management
Keep airway open.
Suction pooled oral secretions as needed.
Elevate head and shoulders.
Keep a calm & peaceful atmosphere.
Support respirations if needed.
Severe Swallowing Difficulty
Subjective findings may include gagging, choking, inability to swallow medications or food, anxiety, restlessness.
Evaluate
airway patency
pooled oral secretions or retained food
strength of cough
respiratory rate & effort
cardiac status
speech effort and quality
Physical examination may reveal drooling, weak cough, pooled secretions, retained food in the mouth, rattling sounds in the throat or chest, slurred or absent speech.
First Responder Management
If actively choking, open mouth and remove any visible food particles.
Perform Heimlich Maneuver only if foreign body (food or other object) obstruction in airway is suspected.
Keep airway open.
Suction pooled oral secretions as needed.
Keep a calm & peaceful atmosphere.
Clinical Manifestations of MG
MG weakness occurs in specific muscles or muscle groups.
MG weakness may fluctuate over time and during the course of the day.
Individuals with MG are usually stronger in the morning.
MG weakness increases after prolonged use of the affected muscles
MG symptoms may worsen with emotional upset, systemic illness, fever, surgery, menses, pregnancy, thyroid dysfunction and drugs affecting neurotransmission.
Crisis
Although a rare occurrence, "crisis" occurs when the individual with MG is unable to breathe or swallow adequately.
"Myasthenic crisis" may result from factors that exacerbate the weakness of the disorder.
"Cholinergic crisis" may result from anticholinesterase overdosage. A commonly prescribed anticholinesterase drug is pyridostigmine bromide (Myestin ).
General Treatment Guidelines
Avoid lengthy questioning as it may unduly fatigue the individual with MG.
Administration of narcotics may worsen symptoms of MG and further compromise breathing.
See also other sections (For Families, Crisis Management)