Myasthenic Crisis and Worst Case Scenario (Nursing)

00:01 Now that brings us to the most serious point when you're dealing with a myasthenic patient.

00:07 Myasthenic crisis is a medical emergency.

00:11 Okay? I want to pause for just a moment because, usually, myasthenia gravis, you lead a full life, there's not a problem, but this is a problem.

00:21 This is a--well, just what we call it.

00:24 It's a crisis. It's a medical emergency.

00:27 Because now the muscles that control breathing are weakened to the point where I can't adequately support the oxygenation that my body needs.

00:37 Sometimes, not often, but sometimes, patients will need a ventilator to help them breathe, so we can get them through whatever stress or trauma may have set off this myasthenia gravis, and then they'll be able to be extubated or stop the ventilator.

00:52 But when a patient with myasthenia gravis is starting to have some respiratory problems, again, that is a super red flag, all hands on deck.

01:02 Now about 15 to 20 percent of people with myasthenia gravis experienced at least one crisis in their life.

01:09 And you know this is kind of my philosophy, if a patient is in the hospital, it might not be for their diagnosis of myasthenia gravis, but if they're in the hospital, they're under stress.

01:19 So I am on uber alert with that patient that they might go into a myasthenic crisis.

01:25 Maybe it's because of just being in the hospital.

01:27 Maybe it's because we-- whatever other comorbidity has brought them into the hospital.

01:32 But when I see that in the history, I am really alert to watching for any respiratory problems.

01:38 Now this requires immediate medical attention.

01:42 Okay, so it might be triggered by infection, stress, surgery, or some type of adverse reaction.

01:47 All those things regularly happen in the hospital which is why I'm always a little bit on edge when I have a patient with myasthenia gravis.

01:55 Now up to one half of the people who have this crisis, may have no obvious reason that we're aware of for the crisis.

02:03 So those are some obvious reasons, right? Infection, stress, surgery, any of those things are obvious.

02:09 But half to the people that end up in crisis, we don't know what set it off.

02:14 Something did. We just don't know what it was.

02:16 So that's why you always need to be on the lookout.

02:20 Now this brings us to my favorite way for you to take notes.

02:23 Okay, so the diagnosis is myasthenia gravis.

02:26 I want you to pause the video and fill in the rest of the columns.

02:31 What is the worst case scenario? How would you recognize it? And then, what would you do? So pause the video, and then we'll come back and talk through it together.

02:47 Okay, welcome back.

02:49 Hopefully, you're able to do that and took some time.

02:51 Now if you've missed any blanks, don't worry, we've got them here for you to fill in.

02:55 So the worst case scenario for myasthenia gravis, well, I don't want to walk around with a droopy eye or looking kind of weird speech, but respiratory failure.

03:03 Remember, myasthenia gravis affects skeletal muscles, your diaphragm is a very thin skeletal muscle.

03:09 So, whoa, if that's not working well, we're gonna be in big trouble.

03:13 How you would recognize it? Some early signs might be difficulty swallowing, some changes in speech, more obvious signs would be the patient would tell you, "I can't really feel like I can breathe," or you might notice that they have an increasing shortness of breath, or if they're on a pulse ox, you might see a change in that.

03:33 Now what you would do, this is not the patient you come back and check on in an hour, hour and a half, you stay with them, you monitor them closely.

03:41 If they don't have a pulse ox on, put one on to see how their oxygenation is going.

03:46 We may consider the need for putting on oxygen.

03:49 But we're going to contact the healthcare provider because this is a big deal.

03:53 We're going to do everything we can to encourage rest for that patient because sometimes things will get better with rest.

03:59 But this is not a patient that we can leave and just come back and check and see how things are going later.

04:04 Stay with them, monitor respirations and oxygenation very closely and contact the healthcare provider.