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.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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