Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute exacerbation of Myasthenia Gravis characterized by progressive respiratory muscle weakness, dyspnea, and orthopnea. Symptoms include worsening bulbar dysfunction (dysphagia, dysarthria), generalized fatigue, and inability to clear secretions. No recent medication non-compliance or identifiable triggers (infection, surgery, stress) noted. Current NIF and VC measurements indicate impending respiratory failure.
Clinical Examination Findings
Patient is in acute respiratory distress, utilizing accessory muscles for respiration. Oropharyngeal exam reveals significant ptosis, ophthalmoplegia, and weak gag reflex. Pulmonary exam: diminished breath sounds, shallow tidal volumes, and poor cough effort. Neurological exam: generalized proximal muscle weakness (Grade 3/5), absent deep tendon reflexes, and rapid fatigue on repetitive testing.
Treatment Protocol
Immediate admission to ICU for airway protection and respiratory monitoring. Initiate mechanical ventilation if NIF < -20 cmH2O or VC < 15-20 mL/kg. Pharmacological management: Plasmapheresis (PLEX) or Intravenous Immunoglobulin (IVIG) therapy. Hold acetylcholinesterase inhibitors during acute phase to reduce bronchial secretions. Monitor for autonomic instability and electrolyte imbalances.