A fictional 59-year-old with myasthenia gravis develops weak cough, nasal speech and difficulty counting after a chest infection. Oxygen saturation is 97% on air.
Listen for the assumption.
The saturation is normal, so I thought respiratory compromise was unlikely.
Oxygen saturation can remain normal until late in neuromuscular ventilatory failure. We need serial respiratory mechanics and bulbar assessment.
I will involve critical care and neurology before exhaustion or aspiration makes airway management emergent.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Weak cough and pooling secretions
- Speech deteriorates during examination
- Recent infection and new antibiotic exposure
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Assess cough, swallow, secretions, speech and respiratory mechanics, and prepare a monitored airway plan.
Good. Coordinate critical care and neurology early; non-invasive support is not a substitute for a safe airway when bulbar function is failing.
I will hand over the trajectory rather than one saturation or one vital-capacity value.
What must remain explicit.
- Use local neuromuscular respiratory-failure and airway pathways.
- Seek early critical-care and neurology input.
- Review drugs that may worsen myasthenia.
Where reasoning fails.
- Relying on saturation
- Waiting for profound hypercapnia
- Ignoring secretion and swallow failure
Myasthenia with bulbar signs [trend], cough/secretions [status], respiratory mechanics [serial values], gas exchange [trend], precipitants/drugs [assessment] and airway plan [status].
Which bedside measures and escalation thresholds are specified in your local myasthenia pathway?