Approach to the Critical Patient

Immediate priorities

Airway and respiratory threats

Circulation threats

Immediate neuromuscular red flags

Monitoring and targets

Monitoring bundle

Escalation triggers

Immediate consults

Consultation triggers

History

Presenting complaint characterization

True weakness vs fatigue distinction

Pattern of weakness

Anatomic distribution

Symmetry clue

Associated symptoms

Neurologic symptoms

Systemic symptoms

Exposure and risk history

Medication review

Antecedent illness

Family and social history

Family history

Social history

Physical Exam

Vitals and general appearance

Vital sign interpretation

General appearance

Neurologic examination

Motor strength assessment

Reflexes

Cranial nerve exam

Sensory exam

Fatigability testing

Gait assessment

Special signs

Dermatomyositis skin findings

Metabolic exam findings

Cauda equina screen

Differential Diagnosis

Life-threatening diagnoses

Neuromuscular emergencies

Systemic emergencies

Most likely diagnoses in the ED

Metabolic and endocrine

Systemic and functional

Other important causes

Inflammatory myopathy

Neuromuscular junction disorder

Chronic neuromuscular disease

Laboratory Tests

First-line labs

Core metabolic and hematologic panel

Second-line labs

Inflammatory and autoimmune markers

Metabolic and nutritional

Infection and sepsis

Third-line specialist-directed labs

Neuromuscular junction antibodies

Neuropathy workup

Myositis-specific antibodies

Diagnostic Tests

Scoring Systems

Neuromuscular functional assessment tools

Bedside respiratory monitoring in neuromuscular disease

Frailty and functional assessment in elderly

MRI

MRI brain

MRI spine

Muscle MRI

CT

CT head

CT chest

CT angiography of neck and brain

Ultrasound

Nerve ultrasound

Muscle ultrasound

Bedside POCUS assessment

Disposition

ICU and high-dependency admission

ICU admission indications

Ward or observation admission indications

Discharge criteria

Safe discharge requirements

Specialist consultation triggers

Consultation indications

Treatment

Immediate stabilization

Emergency resuscitation measures

GBS treatment

Immunotherapy

Supportive care in GBS

Myasthenic crisis treatment

Crisis management

Ongoing myasthenia management

Inflammatory myopathy treatment

Initial immunosuppression

Metabolic and endocrine treatment

Hypothyroidism

Adrenal insufficiency

Anemia

Sepsis treatment

Initial resuscitation

Special Populations

Pregnancy

Pregnancy-specific considerations

Geriatric

Atypical presentation patterns

Functional baseline assessment

Medication considerations

Disposition bias toward admission

Sarcopenia and deconditioning

Pediatrics

Age-specific differential considerations

GBS in children

Weight-based treatment considerations

Developmental considerations

Background

Epidemiology

Prevalence and burden

Pathophysiology

Anatomic classification of weakness etiology

Systemic causes pathway

Therapeutic Considerations

Diagnostic approach before treatment

Treatment principles

Rehabilitation and recovery

Patient Discharge Instructions

copy discharge instructions

Generalized weakness home care

Warning signs to return to the emergency department immediately

Follow-up instructions

Expected recovery information

References

Guidelines and key sources

Primary references

Neuromuscular junction references

Inflammatory and critical illness references

Geriatric and special population references

Imaging and diagnostic references