NeuroMuscular Emergencies

IMPORTANT: This app is intended for use by qualified healthcare professionals only. Always seek the advice of a qualified clinician before making any medical or prescribing decisions.

Neuromuscular Emergencies is a comprehensive evidence-based reference for the recognition and management of acute neuromuscular conditions. Built for neurologists, intensivists, emergency physicians, and allied health professionals managing patients with neuromuscular respiratory failure.

GUILLAIN-BARRE SYNDROME
- Brighton diagnostic criteria and clinical features
- GBS disability scale and IGOS prognosis score
- IVIg protocol: 0.4g/kg/day for 5 days with full administration guide
- Plasma exchange protocol: 200-250 mL/kg over 5 sessions
- Six GBS variants: AIDP, MFS, AMAN, AMSAN, PCB, pure sensory
- Anti-GQ1b, anti-GM1, anti-GD1a antibody significance
- Supportive care: autonomic monitoring, pain management, VTE prophylaxis
- Anti-ganglioside antibody guide and variant recognition

MYASTHENIC CRISIS
- Recognition of impending respiratory failure: single breath count, paradoxical breathing
- Myasthenic vs cholinergic crisis - SLUDGE, pupil changes, clinical comparison table
- 20/30/15 rule: VC below 20, NIF below -30, MEP below 40
- IVIg and plasma exchange protocols - MGTX trial evidence
- Pyridostigmine hold during ICU admission
- New agents: eculizumab (NICE approved), efgartigimod
- Intubation considerations

RESPIRATORY FAILURE IN NM DISEASE
- 20/30/40 rule - visual dashboard of critical thresholds
- Why SpO2 is unreliable in neuromuscular respiratory failure
- Bedside vital capacity technique - 6-step protocol
- Serial NIF measurement technique
- Intubation criteria and weaning criteria
- Peak cough flow assessment

LAMBERT-EATON MYASTHENIC SYNDROME
- LEMS vs MG clinical comparison table
- Anti-VGCC antibody - pathophysiology and diagnosis
- EMG pattern: incremental response at high-frequency stimulation
- 3,4-Diaminopyridine (amifampridine) dosing and mechanism
- Malignancy screen protocol - SCLC association

BOTULISM
- Five types: foodborne, wound, infantile, iatrogenic, inhalation
- Four Ds: diplopia, dysarthria, dysphagia, descending paralysis
- Fixed dilated pupils - key distinguishing feature
- 7-step emergency protocol including PHE contact number
- Heptavalent antitoxin - administration and timing
- Wound debridement for injection drug use botulism

CRITICAL ILLNESS WEAKNESS
- CIM vs CIP comparison table - pathology, NCS, prognosis
- Risk factors and prevention
- MRC sum score
- ICU-acquired weakness

PERIODIC PARALYSIS
- Five syndromes comparison: hypokalaemic PP types 1 and 2, hyperkalaemic PP, Andersen-Tawil, thyrotoxic PP
- Andersen-Tawil triad: paralysis, cardiac arrhythmia, dysmorphic features
- Thyrotoxic PP - propranolol protocol and electrolyte management

NMJ DISORDERS OVERVIEW
- Neuromuscular junction anatomy and physiology
- Complete antibody target table
- EMG patterns
- SFEMG interpretation

DRUG-INDUCED NEUROMUSCULAR DISEASE
- Drugs to avoid in MG
- Statin myopathy spectrum
- Anti-HMGCR autoimmune myopathy
- ICI neuromuscular toxicity: myasthenia, myositis, myocarditis overlap
- Rhabdomyolysis management protocol

ICU MONITORING
- Monitoring frequency table by disease and severity
- Bedside VC, NIF, single breath count, peak cough flow techniques
- Bulbar function assessment protocol
- Autonomic monitoring in GBS: bradycardia, BP lability management

SOURCES AND REFERENCES
25 plus tappable references including EAN GBS Guidelines 2023, EAN/EFNS MG Guidelines, Dutch GBS Study Group IVIg trial, SID-GBS 2023, MGTX trial, REGAIN eculizumab trial, ADAPT efgartigimod trial, Brighton criteria, EMBRACE trial, PHE botulism guidelines and ABCD trial.

DISCLAIMER
This app is intended for use by qualified healthcare professionals only as a clinical decision-support and educational reference tool. It does not replace individual clinical assessment, local neurology protocols or official prescribing information.