Emergency Department and Inpatient Clinical Pathway for Evaluation of Suspected Acute Flaccid Myelitis
Related Pathways
Related Orders
- Save Our Specimen
- ED Suspected AFM Pathway Order Set
- Inpatient Suspected AFM Pathway Order Set
- Transfer from Outside Hospital
- Ensure transfer of all imaging and verify specimens obtained
- Key Features of AFM
- > 1 Flaccid, floppy, low tone extremity
- Proximal > distal weakness
- Decreased or absent deep tendon reflexes in affected extremity
- Cranial nerve dysfunction
- e.g. bulbar dysfunction
- Respiratory
- Time of symptom onset
- Assess for distress
- Increased WOB, tachypnea, retractions
- Perform NIF, VBG as clinically indicated
- Neurologic
- Complete exam
- Assess for cranial nerve and/or bulbar dysfunction
- Facial asymmetry, eye movement abnormalities, weak cough, gag, drooling, swallowing difficulty, inability to handle secretions, inability to hold head up
- Consult Neurology
- Review Differential Diagnosis
- Initial Evaluation
- Respiratory virus panel
- NP swab or aspirate for Enterovirus
- Consider LP in stable patients
- CBC, CMP
- Neuroimaging
- Discuss with Neurology and Neuroradiology
- Order level-appropriate spine MRI
- Consider need for brain MRI
- Sedation Considerations
- > 48 Hours of Clinical Findings
Without Progression of Symptoms
- 48 Hours of Clinical Findings
or
Concern for Progressive Symptoms,
Bulbar or Cranial Nerve Dysfunction,
Cervical Lesions, or Abnormal NIF
Admit to Neurology
Admit to PICU
- Ongoing Care and Monitoring
- Additional Labs
- Consider EMG if minimal recovery 1-2 weeks after presentation for prognosis
- Treatment
- IVIG 2 g/kg as a single dose over 1 day
- Steroids, plasma exchange
- Consider based on individual patient
Posted: February 2022
Revised: September 2022
Authors: S. Hopkins, MD, MSPH; M. Kirschen, MD, PhD; A. Topjian, MD, MSCE; N. Tsarouhas, MD; E. Katz, MD; J. McGuire, MD, MSCE; A. Vossough, MD, PhD; S. Swami, MD; E. Kunzelman, BSN, RN
Revised: September 2022
Authors: S. Hopkins, MD, MSPH; M. Kirschen, MD, PhD; A. Topjian, MD, MSCE; N. Tsarouhas, MD; E. Katz, MD; J. McGuire, MD, MSCE; A. Vossough, MD, PhD; S. Swami, MD; E. Kunzelman, BSN, RN