In this post I link to and excerpt from Emergency Medicine Cases‘ podcast and show notes, Ep156 ED Approach to Acute Motor Weakness. Podcast production, sound design & editing by Anton Helman, voice editing by Raymond Cho, sound design by Yuang Chen. Written Summary and blog post by Priyank Bhatnagar & Saswata Deb, edited by Anton Helman May, 2021.
Drs. Helman, Baskin, and Porfiris podcast and show notes are simply some of the most awesome neurology resources I’ve encountered.
Note to myself:
I only excerpted the section in recognizing respiratory failure in neuromuscular disease because the show notes are perfect and because failure to recognize impending respiratory failure in a patient with possible neuromuscular weakness can lead to disaster.
Review the podcast frequently.
And review the awesome show notes whenever you are evaluating a patient with potential acute motor weakness.
All that follows is from the show notes:
In this Part 1 of of our 2 part podcast on weakness, Episode 156 – Approach to Acute Motor Weakness, with the help of EM physician Dr. George Porfiris, the winner of many teaching awards and Dr. Roy Baskind, neurologist at North York General, creator of a brand-new neuro podcast The Encephalopod, we turn the assessment of the weak patient into a satisfying, frustration-free, experience for you by laying out a simple approach and feeding you the key clinical pearls that will help you clinch the diagnosis. This is not about generalized malaise or fatigue from dehydration or anemia or sepsis. This is not about hypoglycemia, polypharmacy, or medication side effects. This is not about the details of stroke, traumatic spinal cord injuries or chronic neurodegenerative disorders, all of which can present with the chief complaint of weakness. What we do in this podcast is throw out the word “weakness” and instead, zero in on the specific symptoms of loss of true neuromuscular strength. We dig into the patterns of decreased true neuromuscular strength and how they can narrow our differential. We discuss some key associated symptoms that will narrow our differential even further. We simplify the distinction between UMN and LMN and see how that can narrow our differential even further. And in the next part of this two part podcast we review the key features of the most emergent muscle weakness diagnoses we need to act on in the ED…
Recognition and management of respiratory failure associated with neuromuscular disease
Tachypnea is a sign of impending respiratory compromise in the patient with neuromuscular disease
Patients with neuromuscular disease are at particularly high risk of respiratory failure, given the propensity for altered mental status and diaphragmatic and/or accessory respiratory muscle weakness. Tachypnea often presents sooner than, and may herald other signs of, impending respiratory failure.
It is prudent for the ED physician to look for the following when assessing the airway status of patient with motor power loss:
- Abnormal or poor mentation
- Difficulty with speech or weak voice
- Drooling or other indication of difficulty handling secretions
- Inability or difficulty lifting their head off the stretcher
- Weak, rapid, or shallow breaths or use of accessory muscles
Pitfall: A common pitfall is to assume that the cause of tachypnea in a patient with suspected neuromuscular disorder with a normal oxygen saturation is due to acidemia only. Tachypnea is often a sign of impending respiratory compromise in these patients due to neuromuscular compromise that may require a definitive airway.