Airway First, Label Second: Myasthenic, Cholinergic and Guillain–Barré
Myasthenic crisis and cholinergic crisis both arrive as a weak patient who cannot breathe, and students burn precious minutes deciding which one it is. The correct first action is neither. Work the crisis in three steps — support ventilation, then classify, then treat — and then screen an order set for the drugs and orders that put these patients on a ventilator in the first place.
Mrs Ali, room 412, generalised myasthenia gravisAdmitted two days ago with pneumonia. Over four hours her speech has become nasal and she cannot lift her head off the pillow. Respiratory rate 28, saturation 95 percent on room air, weak cough.
Step 1 — what is your first action?
Step 2 — now classify. Tap each finding into a crisis.
Finding 1
Two patients, one order screenHalf of these orders belong to a myasthenic inpatient and half to a patient with Guillain–Barré syndrome on day three of progression. Decide each one: carry it out, or flag it and call the provider.