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1.10 Weakness


Presentation

An older patient comes to the emergency department or is brought by family, complaining of "weakness," or an inability to carry on his usual activities or care for himself.

What to do:

What not to do:

Discussion

Approach the patient with "weakness" with an open mind and be prepared to take some time with the evaluation. Demonstrable localized weakness usually points to a specific neuromuscular etiology, while generalized weakness is the presenting complaint for a multitude of ills. In young patients, weakness may be a sign of psychological depression while in older patients, inaddition to depression, it may be the first sign of a subdural hematoma, pneumonia, urinary tract infection, diabetes, dehydration, malnutrition, heart failure, or cancer. It is important to exclude the Guillain-Barre syndrome as one of the critical, life-threatening etiologies to weakness. The pattern is not always an ascending paralysis or weakness, but usually does depress deep tendon reflexes. Botulism is another condition that must be excluded by history or observation. Patients who are suffering from these sorts of neuro-muscular weakness get into danger when they can't breathe. Pulmonary function studies like pulse oximetry, capnography, blood gases, peak flow or vital capacity can be helpful in selecting patients who might be close to severe respiratory embarrassment.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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