Emergency Department Management of Patients With Complications of Chronic Neurologic Disease: Parkinson Disease, Myasthenia Gravis, and Multiple Sclerosis (Pharmacology CME)

Publication Date: May 2024 (Volume 27, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 05/01/2028.

Specialty CME Credits:Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Jeremy Rose, MD, MPH, FRCPC, FACEP

Medical Director, Emergency Medicine; NYP Columbia University Irving Medical Center; Associate Professor of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY

Caroline W. Burmon, MD

Attending Physician, Maimonides Medical Center, Brooklyn, NY

John Rozehnal, MD

Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Peer Reviewers

Jay Bernstein, MD, MPH, MS, FACEP

Assistant Professor, Vice Chair of Doctoring Phase, Department of Emergency Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH

Linda Papa, MD, CM, MSc, CCFP, FRCP(C), FACEP

Director of Academic Clinical Research, Orlando Health; Professor, University of Central Florida College of Medicine, Orlando, FL; Associate Professor, Florida State University College of Medicine, Tallahassee, FL

Benjamin Schnapp, MD, MEd

Associate Professor (CHS), BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI

Abstract

This issue reviews 3 neurological conditions that can cause or complicate a patient‘s emergency department presentation: Parkinson disease, myasthenia gravis, and multiple sclerosis. Parkinson disease is a common comorbidity, and can be exacerbated in the ED if not managed expeditiously. Myasthenia gravis carries the potential for significant respiratory compromise and requires swift recognition and emergency care. Multiple sclerosis has many manifestions, stages, and treatments that emergency clinicians need to understand to best manage flares. This review presents a summary of the presentations, the common pitfalls, and the roles of various therapeutics in managing patients with chronic neurologic disease.

PART 1: Parkinson Disease

Case Presentation

CASE 1

A 68-year-old man with a history of Parkinson disease presents by EMS to the ED with chest pain…

The patient was given an aspirin by EMS, but he said he missed his routine morning medications.
His Parkinson disease is managed with carbidopa/levodopa 25 mg/100 mg orally 3 times daily. His initial vital signs are: temperature, 37°C; heart rate, 88 beats/min; blood pressure, 130/80 mm Hg; and oxygen saturation, 98% on room air.
He has had 2 electrocardiograms, and both were normal sinus rhythm with no signs of ischemia.
The patient has been waiting in the ED for 8 hours for the results of a second troponin test. He attempts to stand, using his cane, but he falls and sustains a subdural hematoma. Risk management contacts you and inquires whether this adverse event was preventable…

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