Myasthenic Crisis

WHAT YOU SHOULD KNOW:

A myasthenic crisis is a severe form of myasthenia gravis. It is a life-threatening condition that happens if the muscles you use for breathing become very weak. It can cause severe breathing problems and lead to lung failure.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Use of a ventilator to help you breathe may cause an infection or damage to your lungs. The catheter tube used during plasma exchange may cause an infection. Myasthenia gravis increases your risk for abnormal heartbeats or a blood clot in your lungs. If a myasthenic crisis is left untreated, your breathing muscles may continue to weaken. It may be very hard for you to breathe on your own, and your lungs may stop working. This is life-threatening.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

IV fluids:

IV fluids may be given to prevent your blood pressure from becoming too low. They may also help replace any lost fluids and electrolytes (salts) from your body. Conditions such as a fever may cause you to lose fluids from your body.

Rest:

Keep the head of your bed raised to help you breathe easier. You can also raise your head and shoulders up on pillows or rest in a reclining chair. If you feel short of breath, let caregivers know right away.

Breathing support:

  • Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask or nasal cannula. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or nasal cannula bothers you. Ask your caregiver before taking off your oxygen.

  • Ventilator: A ventilator is a special machine that helps you breathe if you cannot breathe well on your own. You may have an endotracheal tube (ET) tube in your mouth or nose. It goes into your trachea (windpipe) to keep your airway open and help you breathe. It may be attached to a ventilator, and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.

  • Bilevel positive airway pressure: Bilevel positive airway pressure (BiPAP) is a device that helps you breathe easier. It allows you to receive oxygen without using a tube in your throat.

  • Suctioning: If you have muscle weakness from your myasthenic crisis, you may have a hard time coughing out your secretions. Suction may be used to remove secretions from your airways so you can breathe easier.

Medicines:

  • Antiulcer medicine: This is given to prevent stress ulcers and bleeding from your stomach.

  • Anticholinesterase medicine: This medicine helps improve energy and muscle strength in a myasthenic crisis.

  • Blood thinners: This medicine is given to help prevent blood clots from forming.

  • Immune globulins: This is given as a shot or an IV infusion to help your immune system. Each infusion can take 2 to 5 hours.

  • Immunosuppressives: This medicine is used to slow down your immune system and slow the progression of myasthenia gravis.

Monitoring:

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

Tests:

  • Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.

  • Chest x-ray: This is done to see how your lungs and heart are doing. It may show signs of an infection, such as pneumonia. Chest x-rays may also show fluid around your heart and lungs.

  • Pulmonary function tests: Pulmonary function tests (PFTs) help caregivers learn how well your body uses oxygen. You breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. PFTs help your caregivers decide the best treatment for you.

  • Swallow study: This is done to make sure liquids and food do not enter your airway when you swallow. This may be needed after caregivers remove your ET tube.

Treatments:

  • Compression stockings: These are tight elastic stockings that put pressure on your legs. The pressure is highest near your toe and decreases as it goes toward your thigh. Pressure stockings help push blood back up to your heart and keeps clots from forming.

  • Plasma exchange: This is a procedure that removes plasma from your blood and replaces it with plasma from a donor. Liquid saline may also be used to replace your plasma.

  • PEG tube: This is also called a feeding tube, G-tube, or gastrostomy tube. A small, flexible tube is put into a small cut in your abdomen. The end of the tube goes into your stomach, which is stitched closed to seal the tube. It may also be placed using an endoscope (a long thin tube passed through the mouth and down into the stomach). The PEG tube is used to give you liquids, food, and medicine. You may need a PEG tube if you are on a ventilator for a long period of time. You may also need a PEG tube if you are having problems swallowing.

  • Tracheostomy: This is a tube to help you breathe. It is put into your trachea (windpipe) through a small opening in your neck called a stoma. This is done if you need to use a ventilator for a long period of time.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Myasthenic Crisis (Inpatient Care)

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