Weakness Hot Case
GENERAL APPROACH
- Unilateral or bilateral weakness
- Upper vs Lower motor neuron lesion
- Brain
- Spinal cord
- Peripheral nerves
- NMJ
- Muscles
INTRODUCTION
CUBICLE
- wheelchair
- walking aids
- hand weights
INFUSIONS
- IVIG (GB, MG, vasculitis)
VENTILATOR
- high level of pressure support (global weakness)
- PEEP (atelectasis, collapse, pneumonia)
MONITOR
- ECG (arrhythmias)
- hypertension/hypotension
- ICP monitor/EVD (SAH, intracranial haemorrhage, TBI)
EQUIPMENT
- plasma exchange (MG, MS, GBS)
- Edgerton spinal bed (spinal cord injury)
QUESTION SPECIFIC EXAMINATION
- neurological
-> paralysed
-> unconscious
-> conscious (CNS, proximal/distal weakness, symmetrical or not)
- hands -> head -> chest -> abdo -> feet -> back
-> cardiovascular
-> respiratory (tracheostomy, VC)
-> abdominal (distension)
- thin skin from steroids
- muscle bulk
- nutritional state
- ongoing issues (sepsis, VTE)
- length of admission
- initial reason for admission (was weakness presenting problems or complication of stay)
RELEVANT INVESTIGATIONS
- CXR
- ABG
- CT head
- nerve conduction studies
- nerve/muscle biopsy (were relevant)
- CK trend
OPENING STATEMENT
- = “Multi-factorial”
- List headings of causes -> clinical signs associated with list
References and Links
- Dhand UK. Clinical approach to the weak patient in the intensive care unit. Respir Care. 2006 Sep;51(9):1024-40; discussion 1040-1. PMID: 16934166.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC