A fictional 48-year-old with myasthenia gravis develops worsening dysphagia, weak cough, breathlessness and difficulty counting aloud after a chest infection.
Frame the danger first.
- Bulbar weakness, weak cough, increasing work of breathing and declining respiratory reserve can precede respiratory arrest.
- Normal oxygen saturation does not exclude impending ventilatory failure.
- Infection, medicines and recent treatment changes may precipitate deterioration.
Act, escalate, reassess.
- Use ABCDE with serial respiratory and bulbar assessment; call critical care and neurology early.
- Follow local neuromuscular-respiratory monitoring and escalation pathways.
- Review potential triggers and medicines with specialists while preparing for controlled airway support if needed.
- Ensure swallowing, secretion management and aspiration risk are addressed.
Red flags that change pace.
- Inability to manage secretions, weak cough, aspiration or rapidly worsening dysarthria
- Fatigue, falling respiratory measurements or rising carbon dioxide concern
- Reduced consciousness, sepsis or need for escalating respiratory support
What makes care less safe.
- Relying on oxygen saturation alone
- Waiting for obvious hypoxia before calling critical care
- Using a fixed IVIG/plasma-exchange choice without neurology input
Say the concern plainly.
Possible myasthenic crisis: bulbar signs [summary], respiratory trend [observations/measurements], triggers/medicines [details], aspiration risk [status] and neurology/critical-care plan [time].