Myasthenic crisis

A guide to the resuscitation of myasthenic crisis in the emergency department.


A 50 year old woman presents with a 2 day history of dysuria, for which she was started on ciprofloxacin last night. Since this morning, she has become increasingly weak, and now finds it impossible to get out of bed. She called 911 when she noticed she couldn’t catch her breath. She wonders whether this might be related to her myasthenia gravis…

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The emergency medicine approach to an unconscious patient

A brief summary of the initial emergency medicine approach to the patient with altered mental status


You are called into resuscitation, where EMS has just finished transferring a 55 year old man onto the ED stretcher. They were called after his family found him unconscious at home. His current GCS is 3… Continue reading “The emergency medicine approach to an unconscious patient”

Management of status epilepticus in the emergency department

A brief review of key actions during the first 10 minutes in the resuscitation room with a patient in status epilepticus


EMS arrives with a 39 year old woman who was found down in a generalized tonic clonic seizure. The seizure has been ongoing for at least 12 minutes now. No information is available about her past history. The paramedics were unable to start an IV, but did administer a dose of IM midazolam…

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VP shunt malfunction

A simplified approach to the initial assessment and management of sick patients with VP shunts in the emergency department


A 4 year old presented to the ED with a mild headache, nausea, and vomiting, and was triaged to the sub-acute area of the department. You are called to the room stat, as the child is now unresponsive with a HR of 55, a BP of 167/65, and a sat of 96% on room air. His mom mentions that he had a VP shunt placed when he was younger, but now has no medical problems. The closest neurosurgeon is 45 minutes away, if everything goes perfectly…

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