Myasthenic patients may present to ED with shortness of breath without obvious signs of distress ( because resp accessory muscles are weak and fatiguing !)
Common precipitants are infections and antibiotics or other meds - sometimes disease course Measure the negative inspiratory pressure or the FVC - if <25 cm h2o or 15L/kg - discuss with icu and neurology need for: NIV or CVM IVIG Plasmapharesis or Steroids Physostigmine is NOT used for acute myasthenia
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