Now that brings us
to the most serious point
when you're dealing
with a myasthenic patient.
Myasthenic crisis is a medical emergency.
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.
This is a--well, just what we call it.
It's a crisis.
It's a medical emergency.
Because now the muscles
that control breathing
are weakened to the point
where I can't adequately support
the oxygenation that my body needs.
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.
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.
Now about 15 to 20 percent of people
with myasthenia gravis
experienced at least one crisis
in their life.
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.
So I am on uber alert
with that patient
that they might go
into a myasthenic crisis.
Maybe it's because of just being
in the hospital.
Maybe it's because we--
whatever other comorbidity
has brought them into the hospital.
But when I see that in the history,
I am really alert to watching
for any respiratory problems.
Now this requires
immediate medical attention.
Okay, so it might be triggered by
infection, stress, surgery,
or some type of adverse reaction.
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.
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.
So those are some obvious reasons, right?
Infection, stress, surgery,
any of those things are obvious.
But half to the people
that end up in crisis,
we don't know what set it off.
We just don't know what it was.
So that's why you always need
to be on the lookout.
Now this brings us to my favorite way
for you to take notes.
Okay, so the diagnosis
is myasthenia gravis.
I want you to pause the video
and fill in the rest of the columns.
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.
Okay, welcome back.
Hopefully, you're able to do that
and took some time.
Now if you've missed any blanks,
we've got them here for you to fill in.
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.
Remember, myasthenia gravis
affects skeletal muscles,
is a very thin skeletal muscle.
So, whoa, if that's not working well,
we're gonna be in big trouble.
How you would recognize it?
Some early signs might be
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.
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.
If they don't have a pulse ox on,
put one on to see
how their oxygenation is going.
We may consider the need
for putting on oxygen.
But we're going to contact
the healthcare provider
because this is a big deal.
We're going to do everything we can
to encourage rest for that patient
because sometimes things
will get better with rest.
But this is not a patient
that we can leave
and just come back and check
and see how things are going later.
Stay with them, monitor respirations
and oxygenation very closely
and contact the healthcare provider.