Myasthenic Crisis Note Template (ICU)
A myasthenic crisis note builder for residents: enter NIF, FVC, airway and antibody status; the respiratory plan, immunotherapy choice and avoid-list write themselves.
Reviewed by Zaka Ahmed, MD Clinical reference · 4 min read
Myasthenic Crisis Note Builder
⚠ Do not enter names, dates of birth, MRNs, or any other identifier. Nothing is stored on our servers.Educational documentation aid for clinicians. It applies published guideline logic to what you enter; it does not know your patient. Verify every line, follow your institutional protocol, and use clinical judgment. Full disclaimer. All builders in one place: the residents’ workspace.
Assistant (beta)
Type or dictate your one-line impression and the assistant fills the fields above; the plan itself still comes from the rule set, not from the model. No identifiers — the text goes to our own server and on to a language-model provider, and is not stored.
My phrases — the builder learns your service
Add the lines your attending always wants. Saved in this browser only and appended to the section you choose every time you build this note.
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
Myasthenic crisis is a respiratory diagnosis managed by trend: the note must carry the numbers and the threshold.
- → Enter NIF and FVC and the builder writes the 20/30/40 thresholds and, when they are crossed or bulbar weakness is present, a red flag for elective intubation or a closely watched BiPAP trial.
- → IVIG and plasma exchange are written as equivalent overall, with the reasons to prefer one (MuSK antibodies, IgA deficiency, renal failure, hemodynamic instability, speed).
- → Steroids start once rescue therapy is under way and the airway is secure, because of the transient worsening at days 5–10 — the builder writes that sequence explicitly.
The medications-to-avoid line
Every note built here carries the list — aminoglycosides, fluoroquinolones, macrolides, intravenous magnesium, beta-blockers, botulinum toxin, quinine derivatives, checkpoint inhibitors, neuromuscular blockers, and high-dose steroids without cover — because the most common preventable trigger of crisis is a well-meant prescription written by someone who did not know the diagnosis.
Extubation is a plan, not an event
When you mark the patient intubated, the builder writes the extubation criteria (NIF and FVC thresholds, cough, secretion burden, immunotherapy under way for two to three days), the pyridostigmine hold and restart, and the avoidance of neuromuscular blockers. Electrolytes matter here too: hypokalemia and hypophosphatemia worsen weakness and get their own line.
Beyond the crisis
The note closes with the steroid-sparing agent, thymoma imaging if not yet done, the neuromuscular clinic follow-up, and the crisis action plan and medication card the patient leaves with.
Frequently asked questions
What is the 20/30/40 rule?
A bedside mnemonic for impending respiratory failure in neuromuscular disease: forced vital capacity under 20 mL/kg, negative inspiratory force weaker than −30 cmH2O, or maximal expiratory pressure under 40 cmH2O. The builder writes the thresholds and, above all, that the trend matters more than any single value.
IVIG or plasma exchange?
Overall efficacy is similar. The builder writes plasma exchange as faster and preferred in MuSK-positive disease or when IVIG is contraindicated (IgA deficiency, renal failure, hypercoagulable states), and IVIG when the patient is hemodynamically unstable or has poor vascular access.
Why does the plan hold pyridostigmine while intubated?
It reduces secretions and removes the confusion between myasthenic and cholinergic weakness during the acute phase; the builder writes a low-dose restart before extubation.
References
- Sanders DB, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology. 2021;96:114–122.
- Gajdos P, et al. Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis. Ann Neurol. 1997;41:789–796.
- Wolfe GI, et al. Randomized trial of thymectomy in myasthenia gravis (MGTX). N Engl J Med. 2016;375:511–522.
- Wendell LC, Levine JM. Myasthenic crisis. Neurohospitalist. 2011;1:16–22.