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
