Precautions for Myasthenia Gravis Crisis

First solve the ventilation problem

Although myasthenia gravis crisis includes cholinergic crisis, myasthenia crisis and antagonistic crisis, it is often difficult to accurately identify them in clinical work. In any case, rapid improvement of patient ventilation is the primary task to solve the crisis.

Early patients show more prominent carbon dioxide retention than hypoxemia. Therefore, we should not rely on the oxygen saturation monitoring value on the monitor, but should closely follow up the arterial blood gas. If there is typical type II respiratory failure, we should give mask balloon assisted ventilation in case of emergency, followed by tracheal intubation/tracheotomy and artificial respiration assisted respiration immediately.

Attention should be paid to frequent lung auscultation and examination of cannula position. In order to avoid ignoring pneumothorax, atelectasis and other complications and cannula slipping out. Most crisis patients should temporarily stop using anticholinesterase drugs to make the receptor fully rest. Active control of infection is directly related to prognosis. In antibiotic selection, the aforementioned aminoglycosides, vancomycin and other drugs that inhibit nerve excitation transmission should be avoided.

Glucocorticoid shock therapy

High-dose glucocorticoid shock therapy can greatly reduce the mortality rate and shorten the crisis period. Under sufficient antibiotic application and good pneumonectomy care, hormone therapy should be applied even if pulmonary infection is complicated.

Step by step offline

With the gradual improvement of myasthenia symptoms and the good control of lung infection, weaning and cannula removal can be considered.

When giving patients a trial weaning, they should proceed step by step and cannot be achieved overnight. At the same time, they should also strengthen communication with patients and encourage their confidence in overcoming diseases.

Author: Huashan myopathy group

The article was reprinted by Clove Garden authorized by the author, and the original text was published on the author’s WeChat public platform.