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\author{katcull13}
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  /Title (neuromuscular-disease-patient-management.pdf)
  /Creator (Cheatography)
  /Author (katcull13)
  /Subject (Neuromuscular Disease Patient Management Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Neuromuscular Disease Patient Management Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{katcull13} via \textcolor{DarkBackground}{\uline{cheatography.com/147541/cs/32095/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}katcull13 \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 17th May, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{multicols*}{3}

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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Types of Neuromuscular Diseases}}  \tn
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Myasthenia Gravis & Chronic Disorder, Acute events of muscle weakness and fatigue. Descending paralysis. \tn 
% Row Count 4 (+ 4)
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Guillain Barre & Ground up, Ascending paralysis. Usually triggered by an acute infectious process. \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
ALS & Amyotropic Lateral Sclerosis. Progressive neuro-degenerative disease \tn 
% Row Count 12 (+ 4)
% Row 3
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Muscular Dystrophy & Rare group of genetic diseases. Duchenne MD is the most common form among children and Myotonic is the most common in adults \tn 
% Row Count 18 (+ 6)
% Row 4
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Multiple Sclerosis & A slow progressive CNS disease, characterized by disseminated patches of demyelination in the brain and spinal cord. Patients usually experience exacerbations and remissions. \tn 
% Row Count 26 (+ 8)
% Row 5
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Spinal Muscular Atrophy Disorders & A group of hereditary disorders characterized by skeletal muscle wasting due to progressive degeneration of anterior horn cells in the spinal cord and of motor nuclei in the brain stem \tn 
% Row Count 35 (+ 9)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Types of Neuromuscular Diseases (cont)}}  \tn
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Post-Polio Syndrome & A group of symptoms that develops years or decades after paralytic poliomyelitis and usually affects the same muscle groups as the initial infection \tn 
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Diaphragmatic Paralysis & May be unilateral where only one side of the diaphragm is affected. \tn 
% Row Count 11 (+ 4)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Clinical Presentation}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{Muscle weakness and fatigue} \tn 
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\mymulticolumn{1}{x{5.377cm}}{Exercise intolerance} \tn 
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pathophysiology of NM Disease}}  \tn
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Inspiratory Muslces & Weakness of these muscles lead to decreased Vt, VC and FRC. May cause atelectasis and alveolar collapse \tn 
% Row Count 4 (+ 4)
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Expiratory Muscles & Weakness of these muscles lead to decreased ability to cough and move secretions. Increased risk of pneumonia. \tn 
% Row Count 9 (+ 5)
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Airway Muscles & Weakness of these muscles lead to decreased ability to protect the airway from aspiration and to speak/swallow. Risk of airway collapse and aspiration pneumonitis \tn 
% Row Count 15 (+ 6)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Lab Findings}}  \tn
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ABG & On arrival, these patient may present with acute ventilatory failure with hypoxemia. \tn 
% Row Count 3 (+ 3)
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PFT & These patients present with decreased lung volumes, decreased MIP and MEP. VC is the most commonly measured parameter for these patients. \tn 
% Row Count 8 (+ 5)
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Creatinine Kinase & Increased in many myopathies. Sign of muscle fiber necrosis. \tn 
% Row Count 11 (+ 3)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Ventilation Strategy}}  \tn
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Indications & 20/30/40 rule: VC \textless{} 20 ml/kg, MIP \textless{}-30 cmH2O and MEP \textless{}40 cmH2O or pH \textless{}7.35/PaCO2 \textgreater{} 45 mmHg \tn 
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Main concerns & Typically these patient's lungs are healthy. Our main concern here is protecting the airway and preventing pneumonia. \tn 
% Row Count 9 (+ 5)
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Target Gas & Since the lungs are not the issue we would expect these patients to have a normal gas. \tn 
% Row Count 13 (+ 4)
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Type of Ventilation & These patient benefit from both positive pressure and negative pressure ventilation. Although PPV is seen most often in the hospital setting. PPV can be invasive or noninvasive \tn 
% Row Count 20 (+ 7)
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Mode & Typically VC-CMV will be used in these patients. \tn 
% Row Count 22 (+ 2)
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Parameters & Normal parameters would be used such as: VT 6-8ml/kg, RR 8-12, flow greater or equal to 60 LPM, Ti 1.0, PEEP 5 and FiO2 0.21. Pplat should be \textless{}30cmH2O. \tn 
% Row Count 28 (+ 6)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adjuncts and Other Treatments}}  \tn
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Inline Suction & Because these patient's muscle are weak they often cannot generate a cough and bronchial hygiene may become difficult. To prevent disconnection with with ventilator, inline suction should be used. \tn 
% Row Count 10 (+ 10)
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Cough Assist & Helps the patient generate a strong cough and improve bronchial hygiene. Cough assist can be used in the long term tracheostomy patient. \tn 
% Row Count 17 (+ 7)
% Row 2
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Incentive \seqsplit{Spirometry/Hyperinflation} Techniques & Helps mobilize secretions and prevents infection. Breath stacking is often used in these patients. \tn 
% Row Count 22 (+ 5)
% Row 3
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Pharmacology & Steroids for MG, plasmapheresis, pain management, sedative and anxiolytic may be required. \tn 
% Row Count 27 (+ 5)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Challenges With Patient Management}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{Most NM diseases have no treatment or have a long process leading to long term care. These patients would be ventilated for a long duration of time likely resulting in the use of a tracheostomy.  \newline % Row Count 4 (+ 4)
Be sure to check cuff pressures regularly and change trach as needed. Normal cuff pressure is 20-30cmH2O.% Row Count 7 (+ 3)
} \tn 
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% That's all folks
\end{multicols*}

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