As a respiratory therapist, it is vitally important to know
more about Myasthenia Gravis. Unfortunately, most therapists know little about
the disease. Most likely, they remember that the disease works its way from the
“mind to the ground” – a catchphrase implemented to help remember that Myasthenia Gravis (MG) works its way down from the “M to the G.”
Myasthenia Gravis comes from the Greek and Latin words and means
“grave muscular weakness.”[1] It is an autoimmune neuromuscular disorder
that weakens the body. Currently, there is no known cause or cure. Common
treatments include Anticholinesterase agents (Mestinon), steroids (Prednisone),
and immunosuppressant agents (Imuran). In addition, thymectomy, plasmapheresis
and intravenous immunoglobulin (IVIG)
have all been used to help treat patients.
As a respiratory therapist, your roll will be to monitor and
care for the MG patient. Performing NIF tests and vital capacity measurements
are crucial in monitoring the strength of the respiratory muscle.
Moreover, should your MG patient be intubated, stay on top of auscultating breath sounds and suctioning frequently. Do not rush the weaning process as most patients who are intubated have been intubated due to an inability to breathe adequately. Let the ventilator give the patient a break. Treat the endotracheal tube as a friend, not an enemy. Although we must wean aggressively patients who have been intubated for respiratory conditions (patients recovering from ARDS), consider slowing down a bit for a neuromuscular condition.
Lastly, provide words of encouragement and display
compassion as you work with both the patient and family. It is very scary to
have the ability to breathe taken away from you. Be diligent in your ventilator
checks, patient assessment, and family interaction.
(This post is dedicated to Sarah G., who showed tremendous faith in Jesus Christ, while being intubated secondary to a Myasthenia Gravis crisis. At a young age (early 20's), no one could have been prepared for what she went through. But Jesus was prepared to go through it with her!)
