A glance on Myasthenia Gravis

What is it?

Autoimmune disease. Thymus create antibody mimic the acetylcholine. This antibody competitively bind to Ach receptor, render it not functioning normally. So muscle didn’t get the signal and become weak/paralyse (depend on the amount of Ach receptor left).

Why body create this antibody?

Probably after insult from Herpes virus or other bacterial infection.

So why should I care?

Due to muscle weakness, patient can have respiratory muscle paralysis and can’t breathe.

So how I detect one?

History

1. Probably patient already diagnosed.

2. Patient come with ptosis, diplopia, cranial nerve palsy.

3. Respiratory difficulty.

4. Proximal muscle weakness.

Test

Most of the test to diagnose should be done by primary team. But at ED, high clinical of suspicion and physical examination will be helpful.

1. Edophronium- i think not proper doing it at ED.

2. Nerve conduction study.

3. Antibody count test.

4. Physical examination: cogan lid twitch, single breath count test (ask patient to count to 50 after max inspiration, if less than 50 bad FVC).

Treatment

At ED

1. Neostigmine 0.5mg-2.5 mg IV/SC/IM then oralized.

2. Steroid, only when patient already on long term steroid therapy. IV 100mg (stress dose). If patient didn’t on steroid therapy don’t give steroid.

3. Intubate if needed.

• Prefer short acting drug such as fentanyl, etomidate, propofol.

• Avoid paralytic agent, both depolarizing or non depolarizing.

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