A 37 year old women with myasthenia graves comes to the emergency department with a fever and cough productive of yellow green sputum. She has been on pyridostigmine for the past few months. The patient has been reluctant to have a thymectomy. Her temperature is 38.9C, blood pressure is 120/76mm Hg, pulse is 112/min, and respirations are 22/min. Pulse oximetry shows 86% oxygen saturation on room air but improves to 95% on 40% facets oxygen. Her respiratory effort is weak. There is a decline on serial measurement of vital capacity. Which of the following is the most appropriate next steps in management?
A. Atropine
B. Endotracheal intubation
C. Increase pyridostigmine dose
D. Intravenous immunoglobulin
E. Plasmapheresis
F. Prednisone
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A. Atropine
B. Endotracheal intubation
C. Increase pyridostigmine dose
D. Intravenous immunoglobulin
E. Plasmapheresis
F. Prednisone
for more check out tumblr blog 2ckqustions