GENERAL WEAKNESS Flashcards
KEY CONCEPTS
Definition: Decrease in muscle power or strength
Mechanisms: Cardio-pulmonary, Metabolic, Neurologic, Infectious, Poisoning
Critical to distinguish between Focal and Generalized; Neurologic vs. Non-Neurologic
Focus on life-threatening causes first
Patients with vague symptoms such as generalized weakness have an increased 30-day mortality.
MCC Generalized Weakness: Infectious > Metabolic > Malignant
MANAGEMENT
INVESTIGATIONS
POC Glucose
Electrolytes
Extended Lytes
CBC
ECG
Troponin
Other:
CRP
CK
Carboxyhemoglobin
Digoxin Level
Ammonia Level
Toxicology Screen
DOCUMENTATION
HISTORY
1. DEFINE WEAKNESS
Primary Weakness: unable to perform task with first repetition
Fatigue: Unable to perform the task repeatedly
Asthenia: feeling of fatigue with absence of weakness
- FUNCTIONAL STATUS
Compare current to previous - DURATION
Acute: seconds - minutes
Subacute:hours - days
Chronic: weeks - months - FOCAL VS. GENERALIZED
- PROXIMAL VS. DISTAL
If generalized - RECENT CHANGES
Trauma
Medication change
Preceding Illnesses
Changes in social history:
EtoH / Drug use, Stressors - ROS
Include Cardio-pulmonary, Metabolic, Neurologic, Infectious, Psych, Pain,
PHYSICAL EXAM
1. NEUROLOGIC:
Document Strength, Muscle Tone,
Deep Tendon Reflex
- CARDIOPULMONARY
Respiratory Effort
Lungs Sounds
Rhythm, murmurs
JVP / HJR
Lower extremity edema - HYDRATION
CRITICAL DDX: NEUROMUSCULAR
LIFE-THREATENING
Cerebrovascular accident
Intracranial hemorrhage
Rabies
Botulism
Tetanus
Myasthenia gravis crisis
EMERGENT
Guillain-Barré syndrome
Transverse myelitis
Spinal cord infarct
Central cord syndrome
Anterior cord syndrome
Cauda equina
Post-Ictal
Porphyria
CRITICAL DDX: NON-NEUROMUSCULAR
LIFE-THREATENING
Myocardial infarction
Dysrhythmia
Sepsis
Hyperkalemia
Hypoglycemia
Poisoning
EMERGENT
Acute anemia
Dehydration
Electrolyte derangements
Endocrinopathies
OTHER
Infection
Physical Fatigue
Rheumatological
Psychiatric
