Announcements: Neuromuscular section updated with more questions.

  • Admit to NICU q 1 hour neuro checks
  • Place on Telemetry
  • Watch for autonomic instability, avoid beta-blockers given risk of complete heart block
  • Address Code Status while in ED, may need intubation
  • Check NIF (Negative Inspiratory Force) and FVC q2hrs x 12hrs then q4hrs. Intubate if NIF < 20 or FVC < 15cc/kg (or 1 liter) or rapid downward trend
  • Do not go by the O2 sat or ABGs for need for intubation as these patients will become hypercarbic before hypoxic. Call RRT at the first sign of respiratory distress
  • Lumbar Puncture (look for albumino-cytological dissociation)
  • Check HIV, CMV,  Hepatitis panel, Campylobacter in stool
  • DVT prophylaxis including SCDs
  • EMG/NCS: absence of ‘F’ waves, conduction block, temporal dispersion
  • May need Plasmapheresis. Consult IR for placement of the line and consult Lab Medicine for initiation of Plasmapheresis
  • May need IVIg 0.4gr/kg/day x 5 days. Check IgA level prior to administration of IVIg as it may cause anaphylaxis in patients with IgA deficiency. Give Acetaminophen and Benadryl prior to each IVIg to decrease HA’s
  • FEN: swallow eval, aspiration risk
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