امرأة عمرها ٣٦ سنة عندها وهن عضلي وبيل، تأخذ بيريدوستيغمين. جاءت بعد عدوى صدرية بضعف شديد مفاجئ، وصعوبة بلع، وصوت ضعيف، وصعوبة تنفس. التنفس ٣٠ وسطحي، والتشبع ٩٣٪، ولا تستطيع العد لعشرة بنفس واحد. ما الأولوية؟

A 36-year-old woman with myasthenia gravis on pyridostigmine presents after a chest infection with sudden severe weakness, dysphagia, a weak voice and breathing difficulty. RR 30 and shallow, SpO2 93%; she cannot count to ten in one breath. What is the priority?

1. Give a sedative because she is very anxious
2. Double the pyridostigmine at home straight away
3. Assess vital capacity and prepare breathing support
4. Give an aminoglycoside antibiotic for the chest infection

Answer: C) Assess vital capacity and prepare breathing support. This is a myasthenic crisis, and respiratory muscle weakness is the main danger. Vital capacity and inspiratory force are monitored; ventilation, IVIG or plasma exchange may be needed. Aminoglycosides worsen weakness.