Diferencia entre revisiones de «Weakness»
(→DDX) |
(→DDX) |
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| Línea 50: | Línea 50: | ||
==DDX== | ==DDX== | ||
# UPPER | # UPPER | ||
## Multiple | ## [[Multiple Sclerosis]] | ||
## Poliomyelitis | ## Poliomyelitis | ||
## [[ALS]] (upper & lower motor) | ## [[ALS]] (upper & lower motor) | ||
| Línea 57: | Línea 57: | ||
### Cord compression | ### Cord compression | ||
## Painless | ## Painless | ||
### Transverse | ### [[Transverse Myelitis]] | ||
### Spinal cord infarct | ### Spinal cord infarct | ||
### Intramedullary tumor | ### Intramedullary tumor | ||
# NERVE | # NERVE | ||
## Guillian-Barre | ## [[Guillian-Barre]] | ||
## Toxic neuropthy (Ciguatera) | ## Toxic neuropthy (Ciguatera) | ||
## Tick paralysis | ## Tick paralysis | ||
| Línea 67: | Línea 67: | ||
## Porphyria | ## Porphyria | ||
# MOTOR END PLATE | # MOTOR END PLATE | ||
## Myasthenia | ## [[Myasthenia Gravis]] | ||
## Botulism (descending) | ## [[Botulism]] (descending) | ||
## Organophosphate | ## [[Organophosphate Poisoning]] | ||
## Lambert-Eaton | ## [[Lambert-Eaton]] | ||
# MUSCLE | # MUSCLE | ||
## Painful | ## Painful | ||
### Rhabdo | ### [[Rhabdo]] | ||
### Alcoholic | ### [[Alcoholic]] | ||
### Myopathy | ### Myopathy | ||
### Polymyositis | ### Polymyositis | ||
| Línea 80: | Línea 80: | ||
### Toxins | ### Toxins | ||
### Hypophos | ### Hypophos | ||
### | ### [[Hypokalemia]] | ||
### Polymyalgia rheum | ### Polymyalgia rheum | ||
## Painless | ## Painless | ||
| Línea 87: | Línea 87: | ||
# MIXED | # MIXED | ||
## Upper & Lower Motor Neuron | ## Upper & Lower Motor Neuron | ||
### ALS | ### [[ALS]] | ||
## Sensory & Motor | ## Sensory & Motor | ||
### | ### | ||
# NON-NEUROMUSCULAR | # NON-NEUROMUSCULAR | ||
## MI | ## [[MI]] | ||
## Resp failure | ## Resp failure | ||
## Sepsis | ## [[Sepsis]] | ||
## Dehydration | ## Dehydration | ||
## Anxiety | ## Anxiety | ||
Revisión del 08:34 5 dic 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
- Hypokalemia
- Polymyalgia rheum
- Painless
- Familial periodic paralysis
- Endocrine
- Painful
- MIXED
- Upper & Lower Motor Neuron
- Sensory & Motor
- NON-NEUROMUSCULAR
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