Medical Surgical Nursing Exam 3
External Fixator
2-3 days redness, serious drainage, warmth. We do not adjust or grab the device to lift it. We clean around the pins and do not go from one pin to another. Q-tip at each pin site, clean with whatever is ordered. Cover with gauze.
Adult Acromegaly
Acromegaly, a disorder caused by an excess of GH in adults, results in enlargement of peripheral body parts and soft tissue, after the fusion of the epiphyseal plates has occurred, without an increase in height Adults: Hands, Feet, Nose, Above Eyebrows (super-ciliary ridge), Chin
Hydrocortisone: Disease & What to know
Addison's Hydrocortisone does not help with calcium, so increase calcium. Suppresses the immune system. They cannot take live vaccines or be around sick people. Take with food, first thing in the morning. It mimics when your adrenal glands would actually release cortisol. Have to be complaint with medications.
Addison's Disease Clinical Manifestations
Addison's disease is characterized by muscle weakness, anorexia, GI symptoms, fatigue, emaciation, dark pigmentation of the mucous membranes and the skin, especially of the knuckles, knees, and elbows, hypotension, and low blood glucose, low serum sodium, and high serum potassium levels. In severe cases, the disturbance of sodium and potassium metabolism may be marked by depletion of sodium and water and severe, chronic dehydration. Tan Skin (dark pigmentated skin) Hypotension & Hypoglycemia Hyponatremia & Hyperkalemia
Cushing's Syndrome- Excess
Adredncortical Activity
What is MS
Antibodies eating away at the myelin sheath, mostly seen in brain and spinal cord Women more than men, diagnostic age 25-35ish
Medications for GBS
Anticoagulation (Warfarin (PO), Heparin (IV or SubQ), Enoxaparin (subQ))- large risk for DVT
What is GBS
Attack of peripheral nerves, myelin Rapid Ascending Weakness, Works up from feet Inability to do voluntary movements Does not attack or destroy the Schwann cell (creates and produces myelin), allows for remyelination during recovery phase
Nursing Role in SIADH
Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status are indicated for the patient at risk for SIADH. Supportive measures and explanations of procedures and treatments assist the patient in managing this disorder.
Casts What to Know
Compartment Syndrome-Pain that does not subside with normal things that are being done. Look out for pressure ulcers, burning is a bad sign (notify the provider). When drying, use palms never fingertips. Do not dry with a hair drier unless you can put it on the low setting or a fan. Check the Color, Warmth, Movement, Sensation. Check the skin before you apply the cast, so we can treat/clean whatever we need to.
Compartment Syndrome Clinical Manifestations
Compartment syndrome is characterized by the elevation of pressure within an anatomic compartment that is above normal perfusion pressure. Compartment syndrome arises from an increase in compartment volume (e.g., from edema or bleeding), a decrease in compartment size (e.g., from a restrictive cast), or aspects of both. The patient with acute compartment syndrome reports deep, throbbing, unrelenting pain, which is unrelieved by medications, seems disproportional to the injury, and intensifies with passive ROM. Frequent assessment of neurovascular function after a fracture is essential and focuses on the "five Ps": pain, pallor, pulselessness, paresthesias, and paralysis
Complications of Casts, Splints, and Braces
Compartment syndrome—the most serious complication of casting and splinting—occurs when increased pressure within a confined space (e.g., cast, muscle compartment) compromises blood flow and tissue perfusion. 6 P's (pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis) Pressure Ulcers Disuse Syndrome: Immobilization in a cast, splint, or brace can cause muscle atrophy and loss of strength, and can place patients at risk for disuse syndrome, which is the deterioration of body systems as a result of prescribed or unavoidable musculoskeletal inactivity
Amputation Clinical Manifestations
Contractures Prevention (leg, no pillows below knee or under stump, lay on stomach to lengthen the legs), Wound Care, Pain, Compress (for prothesis, modeling and compact it), Incision Care
Nursing Management For Post-Surgery Amputation
Control Pain Promote Wound Healing Enhance Body Image Help Resolve Grieving Promote Independent Self Care Help Achieve Physical Mobility
Managing Symptoms of MS
Daily Exercising (walking, swimming, stationary biking, progressive weight bearing) Avoid things that will stress out the body, like hot temps (hot shower, hot bath, hot tub) No Running or Aerobic Exercise or Over Exerting (risk of falls) Voiding Schedule & Drink a set of fluid every 2 hours or straight catheter Eye Patch to Help Diplopia
Clinical Manifestations of Lower Arm Fracture
Deformity, Crepitus, Loss of Function, Pain, Bruising, Warmth, Swelling
Fractures and Patient Education
Describe ongoing therapeutic regimen, including diet and activities to perform (e.g., exercises) and to limit or avoid (e.g., lifting weights, driving a car, contact sports). Describe approaches to control swelling (e.g., elevate extremity to heart level). Consume a healthy diet to promote bone healing. Observe prescribed weight-bearing and activity limits. Participate in prescribed exercise regimen to maintain the health of unaffected muscles and those muscles now needed for safe transfer, mobility, etc. If indicated, demonstrate safe use of mobility aid, assistive device, immobilizing device and transfer technique. Control pain with pharmacologic and nonpharmacologic interventions. Report pain uncontrolled by elevation and analgesics (may be an indicator of impaired tissue perfusion or compartment syndrome)
DI Pharmacology
Desmopressin acetate (DDAVP, Stimate) is the prototype posterior pituitary hormone medication. It is a synthetic analog of ADH Diuretic agents such as furosemide (Lasix) may be used along with fluid restriction if severe hyponatremia is present
Complications of Cushing
Diabetes Poor wound healing Osteoporosis Poor Immune System (so many steroids)
MS Medications
Disease Modifying Drugs-Decrease relapses Corticosteroids, Interferons Adjuvant Meds- Suppress Immune Function Alemtuzumab (Lemtrada)- only use it if other meds do not work, binds to T & B cells to make them less effective (suppress immune function) Donepezil Cholinergic Agonist (Bethanechol Chloride)- increases muscle tone in GU & GI Baclofen- Reduce spasticity (can cause drowsy, dizzy, hypotension, increase blood sugar) cannot drink alcohol or sedatives. Not safe for pregnancy Dantrolene sodium- Muscle relaxant cannot use in liver failure patients, no alcohol or CNS depressants Amphetamine related drugs(Modanfinil (Provigil))-Used to decrease fatigue in MS patients, promotes wakefulness
Clinical Manifestations of MS
Fatigue & Depression Weakness & Numbness & Paresthesia (sensory issues) Ataxia (Difficulty with Coordination) Loss of Balance Spasticity, Muscle Spasm (90% of patients) Pain Diplopia (double vision) Bowel, Bladder, and Sexual Dysfunction
Clinical Manifestations of Femoral Shaft Fracture & Tibia/Fibula
Femoral Shaft: The patient presents with an edematous, deformed, painful thigh and cannot move the hip or the knee. Tibia/Fibula: The patient presents with pain, deformity, obvious hematoma, and considerable edema
Testing for Diabetes Insipidus
Fluid Deprivation Test (withhold fluid for 8-12 hr) Blood Levels of ADH
Cushing's Syndrome Dietary Considerations
Foods high in protein, calcium, and vitamin D are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the patient in selecting appropriate foods that are also low in sodium and calories. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high-protein intake may reduce some of the other bothersome symptoms.
Geriatric Considerations for Pain Management
For acute episodes of pain that occur at irregular intervals, most opioids may be taken as needed; for acute pain that occurs daily and for chronic pain, the drugs should be taken on a regular schedule, around the clock. When a choice of pain-relieving medication is available, use the least amount of the mildest drug that is likely to be effective in a particular situation. Take only as prescribed. If desired effects are not achieved, report to your health care provider. Do not drink alcohol or take other drugs that cause drowsiness (e.g., some antihistamines, sedative-type drugs for nervousness or anxiety, sleeping pills) while taking opioids for pain. Do not smoke, cook, drive a car, or operate machinery when drowsy or dizzy or when vision is blurred from medication. Sit or lie down at least 30 to 60 minutes after receiving an opioid by injection. Injected drugs may cause dizziness, drowsiness, and falls when walking around. If it is necessary to stand up, ask someone for assistance. Avoid constipation, a common adverse effect of opioid analgesics. It may be prevented or managed by eating high-fiber foods, such as whole-grain cereals, fruits, and vegetables, drinking 2 to 3 quarts of fluid daily and being as active as tolerated. If you take these medicines for more than a few days, or if you are the caregiver for someone who takes them, ask a health care provider about a bowel program to prevent constipation. A possible regimen is a daily stool softener (e.g., docusate) and a daily or every other day laxative (e.g., bisacodyl), preferably started at the same time as the narcotic. Docusate and bisacodyl are available over the counter.
GBS Clinical Manifestations
GBS typically begins with muscle weakness and diminished reflexes of the lower extremities. Hyporeflexia and weakness may progress to tetraplegia. Demyelination of the nerves that innervate the diaphragm and intercostal muscles results in neuromuscular respiratory failure. Sensory symptoms include paresthesias of the hands and feet and pain related to the demyelination of sensory fibers. Ascending Weakness Symmetrical Weakness Diminished Reflexes or Absent in Lower Extremities Could affect respiratory Paresthesia & Pain from Demyelination Does not affect consciousness or cognitive
Pediatric Acromegaly
Gigantism (child) Kids can grow to 7-8ft tall Although rare, oversecretion of GH in children before the fusion of epiphyseal growth plates results in pituitary gigantism; a person may grow to be seven or even eight feet tall. Conversely, insufficient secretion of GH during childhood can result in generalized limited growth and pituitary dwarfism
Pelvic Fracture Complications
Hemorrhage and shock are two of the most serious consequences that may occur Long-term complications of pelvic fractures include malunion, nonunion, DVTs, residual gait disturbances, back pain from ligament injury, and dyspareunia and erectile dysfunction
Causes of Cushing's Syndrome
High Cortisol Taking lifelong steroids (prednisone) Pituitary Tumor (over production of ACTH by pituitary which stimulates adrenal gland to produce Cortisol)
Emergency Kit for Addison's Disease
Hydrocorticortisone (pre-filled syringe) Glucose, Salt, Water Sources If you use injection, go to hospital In stressful environment: Increase sodium/salt and increase fluid
Treatment Addison's Disease
Hydrocortisone, Glucose, Mineral Corticosteroids, D5 NS
Pharmacology for Amputations
IV Opioids, Morphine/Hydromorphone- Pain 10-20 minutes to work, Oral once they can tolerate No opioids for phantom pain- Gabapentin, Neurontin or TENS (interrupt pain) Tylenol, NSAIDs
Heparin: Route & Monitor Level & Antidote
IV SubQ APPT Protamine Sulfate
Addison's Disease Crisis Management, Immediate Treatment
Immediate treatment is directed toward combating circulatory shock: restoring blood circulation, administering fluids and corticosteroids, monitoring vital signs, and placing the patient in a recumbent position with the legs elevated. Hydrocortisone (Solu-Cortef) is administered by IV, followed by 5% dextrose in normal saline. Vasopressors may be required if hypotension persists.
Medical Management of Fractures
Immediately after injury, if a fracture is suspected, the body part must be immobilized before the patient is moved. Adequate splinting is essential. Joints proximal and distal to the fracture also must be immobilized to prevent movement of fracture fragments. Fracture reduction refers to restoration of the fracture fragments to anatomic alignment and positioning. Either closed reduction or open reduction may be used to reduce a fracture. In most instances, closed reduction is accomplished by bringing the bone fragments into anatomic alignment through manipulation and manual traction. The extremity is held in the aligned position while a cast, splint, or other device is applied. Some fractures require open reduction. Through a surgical approach, the fracture fragments are anatomically aligned. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) may be used to hold the bone fragments in position until solid bone healing occurs. Reduction and immobilization are maintained as prescribed to promote bone and soft tissue healing. Edema is controlled by elevating the injured extremity and applying ice as prescribed. Neurovascular status (circulation, motion, and sensation) is monitored routinely, and the primary provider is notified immediately if signs of neurovascular compromise develop
What does IVIG do
Immunoglobulin, helps for 2-3 weeks & it helps by taking out antibodies
Impacted intracapsular femoral neck fracture Clinical Manifestations
Impacted intracapsular femoral neck fractures cause moderate discomfort (even with movement), may allow the patient to bear weight, and may not demonstrate obvious shortening or rotational changes.
Pharmacological Cushing's
In Cushing's disease, the goal of drug therapy is to inhibit one or more enzymes contained in cortisol synthesis. The antifungal drug ketoconazole has the ability to inhibit these enzymes. Health care providers use the antineoplastic drug mitotane (Lysodren) for the treatment of adrenocortical carcinoma. The drug may also be useful for therapy of Cushing's disease caused by such carcinoma
Cause of Diabetes Insipidus
Insufficiency of ADH or loss of sensitivity in nephrons circulating ADH Head Trauma, Brain Tumor, Brain Surgery, CNS Infection
Treatment of Diabetes Insipidus
Lots of fluid
Cause of Addison's disease
Low Cortisol and Low Aldosterone Causes: Adrenal Gland is Damaged and Cannot Produce 2nd Cause: Pituitary dysfunction without ACTH Autoimmune or Infection (TB)
When would you hold Dessmopressin
Low Creatinine Clearance
Complication of SIADH
Low sodium can cause brain to swell
Diuretic Used in SIADH
Mannitol (osmotic diuretic)
Use of PCA
More autonomy in pain control Not all patients are not able to use and does not work when people push the button for the patient People who can use can push button themselves, awake, know what it is for and how to use it,
After Cast Taken Off
Muscle atrophy, physical therapy, Isometric Exercises- prevent atrophy (disuse syndrome) with moving the muscle without moving the bone,
Medications- Fibromyalgia
NSAIDS- muscle pain and stiffness (Ibuprofen) Tricyclic Antidepressants- (Amitriptyline (Elavil)) improve or restore sleep patterns Muscle Relaxants- (Cyclobenzaprine (Flexeril or Amrix))- relaxation and pain Gabapentin- helps neurological pain (nerve pain). Gabapentin (Neurontin) for treatment of partial seizures. Tramadol- opioid like affects. Tramadol (Ultram, ConZip) is an oral, synthetic, Schedule IV opioid that acts at the central opioid receptors for moderate to severe pain. Because it has a low potential for producing tolerance and abuse, it may be used long-term for the management of chronic pain. It is not chemically related to opioids and is not a controlled drug. Complementary Alternative Medicine (CAM)- acupuncture, massage, hydrotherapy, essential oils Ramelteon (Rozerem), a melatonin agonist, is used for the long-term treatment of insomnia characterized by difficulty with sleep onset. Eszopiclone (Lunesta)is the first oral nonbenzodiazepine hypnotic to receive FDA approval for long-term use (less than or equal to 12 months).
Medical Management of MS
No cure exists for MS. An individual treatment program is indicated to relieve the patient's symptoms and provide continuing support, particularly for patients with cognitive changes, who may need more structure and support. The goals of treatment are to delay the progression of the disease, manage chronic symptoms, and treat acute exacerbations. Common symptoms requiring intervention include ataxia, bladder dysfunction, depression, fatigue, and spasticity. Management includes pharmacologic and non-pharmacologic strategies.
2 Big Things with MG
No sensory impairment No Coordination Issues
What to avoid in patients with MG?
Novocain
Warfarin: Route & Monitor Level & Antidote
PO INR Vitamin K
Fractures Clinical Manifestations
Pain Loss of function Deformity Shortening Crepitus Localized edema andecchymosis
What is a concern found with a tib/fib fracture?
Perineal Nerve Damage for Tib/Fib, if they cannot dorsiflex their big toe. Permanently Dropped
Clinical Manifestations Myasthenia Gravis
Ptosis (drooping eye lids), Diplopia, Blurred Vision Bulbar Symptoms (face, throat, mouth) Weakness of face and throat muscles Dysphagia Dysphonia (voice impairment) Generalized Weakness Respiratory Concerns (diaphragm is muscle)
What would you not expect with a lower arm fracture
Pulselessness, Numb Hand, Tingling
Medications- MG
Pyridostigmine bromide (Mestinon)- first line therapy inhibits acetylcholine breakdown to hope for some to cling to muscle cells. Must be given exactly how scheduled Neostigmine- Long term treatment, skeletal muscle tone and strength improved also increases tone in GI, relaxes bronchial, increase salivary gland secretion, decreases HR, increases contractility of smooth muscles (detrussor) Immunomodulating drugs- only use if the other two do not work, reduces production of antibodies Corticosteroids Cytotoxic Meds (Azathioprine)- reduces production of antibodies IV Immune Globulin (IVIG)- used for exacerbations. Effects last for 28 days
What is MG
Severe muscle weakness Characterized by degrees of weakness Normal life expectancy Women more than men till 50 then equal Antibodies attach to acetylcholine receptors sites so that acetylcholine cannot bind. Impairs signal to muscle cells, muscles are not being triggered Thymus gland is believed to be the site of the antibodies being produced
After Cast is Placed
Signs to report, bad smell can mean incision is getting infected, itching is normal (do not stick anything down cast to itch), avoid getting it wet, normal healing 6-8 weeks. Call for smell, pain that doesn't go away, change in color (toes, fingers), inability to move fingers/toes, change in sensation.
Enoxaparin: Route & Monitor Level
Subq PPT
Diagnostic Tools for MG
Tensilon Test (edrophonium is administered IV, after 30 seconds, the facial muscles and ptosis should stop for 5 min. If it resolves, it is positive which means positive MG Ice Test: ice on patient's eyes for one minute, the symptoms should resolve which means positive for MG EMG: Muscle, electric muscle picture. Usually do not do Imaging for enlarged thymus gland
Treatment Humeras Neck Fracture
The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk. Limitation of motion and stiffness of the shoulder occurs with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate.
Routine Pharmacology for Addison's disease
The goal of treatment for Addison's disease is to replace the adrenocorticoids to correct adrenal insufficiency. It is important to replace both the mineralocorticoid and adrenocorticoid. Lifetime hormone replacement is necessary. If a patient with Addison's disease requires additional mineralocorticoid supplementation, then Fludrocortisone, a synthetic steroid, is useful. A patient usually takes it in combination with a glucocorticoid
Addison's Disease- Dietary Considerations
The nurse encourages the patient to consume foods and fluids that assist in restoring and maintaining fluid and electrolyte balance. Along with the dietitian, the nurse helps the patient select foods high in sodium during GI disturbances and in very hot weather. Increasing fluid intake and salt with excessive perspiration. Ensuring high-carbohydrate, high-protein diet with adequate sodium intake.
Treatment Elbow Fracture
The nurse needs to monitor the patient regularly for compromised neurovascular status and signs and symptoms of acute compartment syndrome. If Volkmann contracture develops, fasciotomy may be necessary with débridement of the muscle. The goal of therapy is prompt reduction and stabilization of the distal humeral fracture, followed by controlled active motion after swelling has subsided and healing has begun. If the fracture is not displaced, the arm is immobilized in a posterior long-arm splint for 2 to 3 weeks. At that point, ROM exercises can begin with the use of a hinged brace
Non-Opioid Management of Pain
The recommended approach for the treatment of all types of pain in all age groups is called multimodal analgesia. A multimodal regimen combines drugs with different underlying mechanisms, which allows lower doses of each of the drugs in the treatment plan, reducing the potential for each to produce adverse effects. Acetaminophen & Ibuprofen
SIADH
The syndrome of inappropriate antidiuretic hormone (SIADH) secretion includes excessive ADH secretion from the pituitary gland even in the face of subnormal serum osmolality. Patients with SIADH cannot excrete a dilute urine, retain fluids, and develop a sodium deficiency known as dilutional hyponatremia.
Treatment MG (not meds)
Therapeutic Plasma Exchange (TPE): Central line, take out blood, separate blood from plasma, remove own plasma and put someone else's plasma in (antibodies in plasma) improves symptoms 75% of time, effects for 3 weeks Thymectomy: removal of thymus gland (under age 65, had disease for less than 3 years) Only thing that could resolve completely
Nursing Care for Rib Cage Fractures
To help the patient cough and take deep breaths and use an incentive spirometer, the nurse may splint the chest with their hands, or may educate the patient on using a pillow to temporarily splint the affected site. NSAIDs may be prescribed to provide analgesic relief. Occasionally, an anesthesia care provider administers intercostal nerve blocks or epidural analgesia to relieve pain and to improve respiratory function. Chest binders to immobilize the rib fracture are not used, because decreased chest expansion may result in atelectasis and pneumonia. Incentive spirometer use may aid in prevention of these complications. The fracture heals within six weeks.
What med can you not give elderly with amputation>
Watch liver function, start low doses and work up, Meperidine (Dermol) do not give
Humeras Shaft Fracture
Well-padded splints are used to initially immobilize the upper arm and to support the arm in 90 degrees of flexion at the elbow. A sling or collar and cuff support the forearm. The weight of the hanging arm and splints put traction on the fracture site. External fixators are used to treat open fractures of the humeral shaft. ORIF of a fracture of the humerus is necessary with nerve palsy, blood vessel damage, comminuted fracture, or displaced fracture. Functional bracing is another form of treatment used for these fractures. A contoured thermoplastic sleeve is secured in place with interlocking fabric (Velcro) closures around the upper arm, immobilizing the reduced fracture. As swelling decreases, the sleeve is tightened, and uniform pressure and stability are applied to the fracture. The forearm is supported with a collar and cuff sling
Treatments Clavicle Fracture
When the clavicle is fractured, the patient assumes a protective position, slumping the shoulders and immobilizing the arm to prevent shoulder movements. The treatment goal is to align the shoulder in its normal position by means of closed reduction and immobilization. clavicular strap, also called a figure-eight bandage may be used to pull the shoulders back, reducing and immobilizing the fracture. A sling may be used to support the arm and relieve pain. The patient may be permitted to use the arm for light activities within the range of comfort
Extracapsular femoral fractures of the trochanteric or subtrochanteric regions- Clinical Manifestations
With extracapsular femoral fractures of the trochanteric or subtrochanteric regions, the extremity is significantly shortened, externally rotated to a greater degree than intracapsular fractures, exhibits muscle spasm that resists positioning of the extremity in a neutral position, and has an associated area of ecchymosis.
Femoral Head Fracture Clinical Manifestations
With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated. The patient reports pain in the hip and groin or in the medial side of the knee. With most fractures of the femoral neck, the patient cannot move the leg without a significant increase in pain. The patient is most comfortable with the leg slightly flexed in external rotation.
Diabetes Insipidus Clinical Manifestations
Without the action of ADH on the distal nephron of the kidney, an enormous daily output (greater than 250 mL per hour) of very dilute urine with a specific gravity of 1.001 to 1.005 occurs. The urine contains no abnormal substances such as glucose or albumin. Because of the intense thirst, the patient tends to drink 2 to 20 L of fluid daily and craves cold water. In adults, the onset of DI may be insidious or abrupt. The disease cannot be controlled by limiting fluid intake, because the high-volume loss of urine continues even without fluid replacement. Attempts to restrict fluids cause the patient to experience an insatiable craving for fluid and to develop hypernatremia and severe dehydration. Peeing non-stop, crystal clear, cannot have concentrated urine Low urine osmolarity (concentration) Serum Osmolality High Hypokalemia & Hypernatremia Polyuria & Polydipsia 1.001-1.005 Urine Specific Gravity (normal for them)
Cushing's Syndrome Clinical Manifestations
Women Mostly "Moon-faced" and increased oiliness of skin The classic picture of Cushing syndrome in the adult is that of central-type obesity, with a fatty "buffalo hump" in the neck and supraclavicular areas, a heavy trunk, and relatively thin extremities. The skin is thin, fragile, and easily traumatized; ecchymoses (bruises) and striae develop. The patient complains of weakness and lassitude. Sleep is disturbed because of altered diurnal secretion of cortisol. Excessive protein catabolism occurs, producing muscle wasting and osteoporosis. Kyphosis, backache, and compression fractures of the vertebrae may result. Retention of sodium and water occurs as a result of increased mineralocorticoid activity, producing hypertension and heart failure Moon Face Buffalo Hump Central Obesity (thin extremities) Thin Fragile Skin, Easily Bruised, Abdominal Stretch Marks Acne Hirsutism Hypertension & Hyperglycemia Infertility
Treatment of MG Crisis
severe muscle weakness, will not be able to breath, respiratory failure, intubate and ventilate. Do not give patient tranquilizers or sedatives
