A 64-year-old man, diagnosed with myasthenia gravis 1 year ago, treated with low-dose steroids (3 mg/day of deflazacort) and anticholinesterase drugs, asymptomatic for 6 months, consults for mild difficulty in swallowing and evening diplopia for a few days. He was admitted to the hospital for suspected myasthenic crisis and treatment was started. The next day the patient alerts at 03 hours in the morning because the patient makes a strange noise when breathing in, like a soft snoring, the patient is sound asleep and very sweaty, but does not seem to be fatigued. What is the most correct attitude?
This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement. The respiratory symptoms correspond to an exhaustion of the muscles, first inspiratory and then accessory (the patient does not appear fatigued or tachypneic because the muscles are exhausted), progressing to a carbonic coma.
Reassure the nurse and family that the patient is a habitual snorer and is peacefully asleep. The patient should be placed in lateral decubitus.
Notify intensive care for suspected acute respiratory failure, to assess possible orotracheal intubation and assisted ventilation.
Perform polysomnographic study to rule out sleep apnea.
Decrease steroid dose; if he has a steroid myopathy he will improve.
Order a thoracic CT scan to rule out compressive thymoma over the trachea associated with myasthenia.
This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement.