approach to weakness

weakness

Weakness has a broad differential and requires a broad approach

A

B: CHEST:

  • Collapse: pneumo
  • Hyperinflate: asthma/COPD
  • Effusion
  • Sick pneumonia
  • Tumour

C: CARDIOVASCULAR:

  • Cardiac arrhythmia
  • Around heart: pericardial effusion
  • RV strain: PE
  • Dysfunctional LV: ACS, CHF
  • Incompetent valve
  • Outflow: dissection
  • Volume loss
  • Abdominal bleed
  • Soft tissue bleed
  • Child-bearing: ectopic
  • Urticarial anaphylaxis
  • Lactate sepsis
  • Addisons
  • Rx

D: NEUROLOGIC:

  • N
  • Encephalitis, meningitis
  • Unregulated pressure
  • RBC bleed/clot
  • Onco tumour
  • myeLopathy: transverse myelitis, spinal cord compression
  • Origin (root) compression, eg herniated disc
  • GBS
  • Intersection neuromuscular: botulism, myasthenia
  • CK myopathy: polymyositis, muscular dystrophy

E: ENDO

  • Electrolyte: glucose, sodium, potassium, magnesium
  • hOrmones: thyroid, cortisol

F: CREATININE: renal failure

G: ABDOMINAL

H: HEME:

  • Hgb: ANEMIC

I: INTOX

  • Ingest
  • Naturopathic
  • Treatment: benzo, diuretic, beta blocker, steroids etc
  • OTC
  • X poison: carbon monoxide

J

 

Putting this together you get a streamlined approach to resuscitation and investigation in the weak patient

  • A: assess airway protect
  • B: assess/support oxygenation/ventilation, listen to chest and examine with bedside ultrasound, consider CXR and ABG
  • C: check HP, BP, assess ECG, ultrasound cardiac/IVC/abdomen, consider fluids, measure CBC +/- trop/dimer/lactate
  • D: thorough neurological exam, consider CT head, MRI spine
  • E: check bedside glucose, measure and normalize electrolytes, consider measuring hormones
  • F: measure renal function
  • G: examen abdomen
  • H: measure Hgb
  • I: consider exposures

weakness

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