Respiratory status should be based on neck flexion strength while lying flat, difficulty clearing secretions, weak cough, pausing during speech, using accessory muscles for respiration/paradoxical abominal breathing, and counting <15 in a single breath. SpO2 is not reliable. If these are present, consider elective intubation. You can also use the 20/30/40 rule: electively intubate if VC<20, OR NIF<-30, OR maximal expiratory pressure <40. You can consider BIPAP in those with dyspnea but have adequate cough, no secretions, and can tolerate the mask. If pCO2<45, BIPAP is unlikely to be successful.
Current Symptoms
New or worsening...
Triggers for Exacerbation
Recently started medications known to exacerbate MG
NOTE: if patient on high dose daily pyridostigmine (>120mg q3h), perform SLUDGE cholinergic crisis screen
Disease History Current outpatient neurologist: _______ Date MG Diagnosed: _______ How was MG diagnosed?
Date of last outpatient visit: _______
Current MG medication regimen
History of Prior Exacerbations What symptoms did they experience?