Unit VII Case Study Instructions Paramedic Sanders was called to the residence of a man who was feeling extremely ill. Upon arrival, the man showed very weak extremities and was unable to ambulate or

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Introduction:
Myasthenia gravis is a neuromuscular disorder that affects the communication between the nerves and the muscles. It is an autoimmune disorder that can result in muscle weakness and fatigability, especially in the muscles that control eye and eyelid movement, facial expression, chewing, swallowing, and breathing. In this case study, a patient with a history of myasthenia gravis presented with respiratory insufficiency, and as such it is important to understand the disease and its effects on the body to provide effective treatment.

1. What is myasthenia gravis? 
Myasthenia gravis is an autoimmune disorder that affects the neuromuscular junction (NMJ), the point where the nerve cells meet the muscles they control. It is caused by antibodies that attack the receptors on the muscle side of the NMJ, leading to decreased nerve signaling and muscle weakness.

2. How does the disease affect the muscle system on a cellular level? 
Myasthenia gravis affects the muscle system on a cellular level by interfering with the normal transmission of nerve impulses to the muscles. The antibodies produced in myasthenia gravis bind to the acetylcholine receptors on the muscle cells, which results in a decreased amount of receptors available for acetylcholine binding. This means that the muscles cannot contract normally, which leads to muscle weakness and fatigability.

3. According to standard treatment protocols, what treatment modalities would you elect to utilize on this patient? 
The standard treatment modalities for myasthenia gravis include acetylcholinesterase inhibitors, immunosuppressive medications, and plasmapheresis or intravenous immunoglobulin (IVIG) therapy. In this case, given the patient’s respiratory insufficiency, the first line of treatment would be to administer oxygen and to provide respiratory support as needed. Acetylcholinesterase inhibitors or corticosteroids would be used to prevent further antibody formation and to improve muscle function.

4. Explain why you selected to utilize this protocol treatment. How is it effective physiologically on the patient’s body? 
The administration of acetylcholinesterase inhibitors or corticosteroids helps to prevent further antibody formation and to improve muscle function by increasing the available acetylcholine at the NMJ. This leads to increased nerve signaling and improved muscle contractions. Plasmapheresis or IVIG therapy can be used to remove or neutralize the antibodies that are attacking the NMJ, which can help to improve muscle function as well.

5. If the treatment you utilized on-site is successful, what should the patient’s outcome be after treatment?
If the treatment is successful, the patient’s muscle weakness and respiratory insufficiency should improve. The patient’s ability to ambulate and to raise their head should also improve, and they should be able to open their eyes. Regular follow-up appointments with the patient’s physician and evaluation of the patient’s symptomatology will help to ensure that the patient’s condition remains stable.