Diferencia entre revisiones de «Weakness»
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| Línea 11: | Línea 11: | ||
==Diagnosis== | ==Diagnosis== | ||
=== | ===Upper Motor Neuron=== | ||
* BRAIN | * BRAIN | ||
**Weakness - variable | **Weakness - variable | ||
| Línea 26: | Línea 26: | ||
**Pain - +/- | **Pain - +/- | ||
=== | ===Lower Motor Neuron=== | ||
* NERVE | * NERVE | ||
**Weakness - distal and ascends | **Weakness - distal and ascends | ||
| Línea 34: | Línea 34: | ||
**Pain - no | **Pain - no | ||
=== | ===End-Plate/Muscle=== | ||
* MOTOR END PLATE | * MOTOR END PLATE | ||
**Weakness - head and descends | **Weakness - head and descends | ||
| Línea 99: | Línea 99: | ||
## Malignancy | ## Malignancy | ||
== | ==Emergent Threat/ED Workup== | ||
# CORD | # CORD | ||
## paralysis | ## paralysis | ||
| Línea 114: | Línea 114: | ||
## serum K+ | ## serum K+ | ||
=== | ===Intubation Indications=== | ||
# Severe fatigue | # Severe fatigue | ||
# Inability protect airway | # Inability protect airway | ||
Revisión del 23:28 28 mar 2011
Background
Acute/Generalized
Workup
- cbc
- chem 10 (esp. K, Mg, Ca, Phos)
- ecg
- +/- CK (r/o myopathy)
- +/- FVC (eval impending resp failure, i.e. Myasthenia)
- +/- ABG/CT/LP/TSH/UA (rhabdo)
Diagnosis
Upper Motor Neuron
- BRAIN
- Weakness - variable
- Bowel/Bladder -
- Reflexes - increased
- Sens - diminished
- Pain - no
- Asymmetric/unilateral
- CORD
- Weakness - fixed level
- Bowel/Bladder - YES
- Reflexes - increased
- Sens - diminished
- Pain - +/-
Lower Motor Neuron
- NERVE
- Weakness - distal and ascends
- Bowel/Bladder - NO
- Reflexes - diminished
- Sens - nl/paresthesias
- Pain - no
End-Plate/Muscle
- MOTOR END PLATE
- Weakness - head and descends
- Bowel/Bladder - NO
- Reflexes - nl/diminished
- Sens - nl
- Pain - no
- MUSCLE
- Weakness - proximal
- Bowel/Bladder - NO
- Reflexes - nl/diminished
- Sens - nl
- Pain - +/-
DDX
- UPPER
- Multiple sclerosis
- Poliomyelitis
- ALS (upper & lower motor)
- CORD
- Painful
- Cord compression
- Painless
- Transverse myelitis
- Spinal cord infarct
- Intramedullary tumor
- Painful
- NERVE
- Guillian-Barre
- Toxic neuropthy (Ciguatera)
- Tick paralysis
- Diabetic neuropathy
- Porphyria
- MOTOR END PLATE
- Myasthenia gravis
- Botulism (descending)
- Organophosphate poisoning
- Lambert-Eaton
- MUSCLE
- Painful
- Rhabdo
- Alcoholic
- Myopathy
- Polymyositis
- Dermatomyositis
- Toxins
- Hypophos
- Hypo-kalemia
- Polymyalgia rheum
- Painless
- Familial periodic paralysis
- Endocrine
- Painful
- MIXED
- Upper & Lower Motor Neuron
- ALS
- Sensory & Motor
- Upper & Lower Motor Neuron
- NON-NEUROMUSCULAR
- MI
- Resp failure
- Sepsis
- Dehydration
- Anxiety
- Fibromyalgia/chronic fatigue
- Malignancy
Emergent Threat/ED Workup
- CORD
- paralysis
- MRI, neurologist
- NERVE
- resp failure
- FEV1, airway mgt, ticks?, neurologist
- MOTOR END PLATE
- resp failure
- FEV1, airway mgt, Tensilon Test?
- MUSCLE
- Rhabdo
- urine myoglobin, serum CK, BUN/Cr
- serum K+
Intubation Indications
- Severe fatigue
- Inability protect airway
- Rapidly increasing PaCO2
- Hypoxemia despite O2
- FVC <12 mL/kg
- Neg Insp Force <20 cm H2O
Source
2/26/06 DONALDSON (adapted from Rosen, Lampe, Birnbaumer)
adapted from Hockberger