A 68-year-old man with myasthenia gravis is evaluated for prog | Uworld | Step 2ck

A 68-year-old man with myasthenia gravis is evaluated for progressive weakness while hospitalized. The patient was admitted 2 days prior due to fever, productive cough, and pleuritic chest pain. Chest x-ray demonstrated a right lower lobe consolidation for which the patient has been receiving intravenous ceftriaxone and azithromycin. He also has been receiving his outpatient dose of pyridostigmine.
In the past several hours,
he has experienced progressive generalized weakness and an inability to cough out sputum. His temperature is 37.6 C (99.8 F), blood pressure is 130170 mm Hg, pulse is 11 Of min, and respiratory rate is 25fmin. Oxygen saturation is 89°/o on 4 Umin oxygen by nasal cannula. The patient appears to be in distress, and his breathing pattern is rapid and shallow with occasional gurgling sounds. Lung auscultation reveals coarse crackles throughout There is mild weakness of the extremities, but deep tendon reflexes are normal. His vital capacity is now 1.0 L compared to 1.5 Lat the time of admission, and arterial blood gas shows pH 7.27, pC02 55 mrn Hg, and p02 60 mm Hg. The patient is intubated and moved to the intensive care unit