What is the immediate treatment for a paralysis attack?

Immediate Treatment for Paralysis Attack

The immediate treatment for acute paralysis depends critically on the underlying cause, but the first priority is always airway protection and respiratory support, followed by rapid identification of whether this is a stroke, spinal cord injury, toxin exposure, or other reversible cause requiring specific emergency intervention.

Initial Emergency Assessment and Stabilization

Airway and Breathing (First Priority)

• Assess respiratory function immediately by checking respiratory rate, oxygen saturation, work of breathing, and ability to protect the airway 1
• Intubate and provide mechanical ventilation if there is respiratory muscle weakness, inability to protect airway, or signs of respiratory distress 1
• Monitor for paradoxical breathing patterns, which can indicate diaphragmatic paralysis even when facial expression appears calm due to facial muscle paralysis 1
• Serial objective measurements through spirometry, EtCO2 monitoring, or blood gas analysis are essential to detect deteriorating respiratory function 1

Circulation and Monitoring

• Establish IV access immediately 1
• Continuously monitor cardiac rhythm and frequently measure blood pressure 1
• Assess for signs of shock or hemodynamic instability 1

Rapid Diagnostic Differentiation

Critical History Elements

• Onset timing: Sudden onset suggests stroke or cardiac arrest; gradual progression over hours to days suggests toxin exposure, Guillain-Barré syndrome, or botulism 1, 2
• Distribution pattern: Unilateral facial weakness with forehead involvement suggests Bell's palsy; bilateral descending paralysis suggests botulism; ascending paralysis suggests Guillain-Barré 2, 1
• Exposure history: Recent food ingestion (botulism), pesticide exposure (organophosphate poisoning), or nerve agent exposure in bioterrorism context 1

Physical Examination Priorities

• Assess facial symmetry and forehead function to distinguish peripheral (Bell's palsy) from central (stroke) causes 2
• Test eye closure ability as incomplete closure requires immediate eye protection measures 2
• Evaluate bulbar function: dysphagia, dysarthria, nasal voice, drooling, impaired gag reflex 1
• Check pupillary responses and extraocular movements to identify cranial nerve involvement 1

Cause-Specific Emergency Treatments

If Cardiac Arrest (Sudden Collapse with Unresponsiveness)

• Presume sudden cardiac arrest and initiate CPR immediately with high-quality chest compressions 1
• Attach defibrillator immediately and deliver shock within 2 minutes if shockable rhythm present 1
• Continue CPR with minimal interruptions until return of spontaneous circulation 1

If Bell's Palsy (Acute Unilateral Facial Paralysis)

• Prescribe oral corticosteroids within 72 hours of symptom onset: prednisolone 50 mg daily for 10 days OR prednisone 60 mg daily for 5 days followed by 5-day taper 2
• Implement immediate eye protection for patients with impaired eye closure: lubricating drops frequently during day, ophthalmic ointment at night, eye taping or patching with proper technique instruction 2
• Refer to ophthalmology if severe eye closure impairment 2

If Botulism Suspected (Descending Paralysis, Bulbar Symptoms)

• Contact CDC immediately (24-hour botulism consult service) to arrange emergency clinical consultation and antitoxin shipment 1
• Administer botulinum antitoxin (BAT) as soon as possible, ideally within 24 hours and no later than 48 hours of symptom onset 1
• Standard adult dose is one vial by IV infusion; pediatric dose is weight-based 1
• Antitoxin stops progression but cannot reverse existing paralysis 1

If Organophosphate/Nerve Agent Poisoning Suspected

• Administer atropine immediately: 2 mg IV for adults, 0.02 mg/kg for children, repeated every 5-10 minutes until muscarinic symptoms controlled 1
• Give pralidoxime chloride (2-PAM): initial dose followed by repeated doses at hourly intervals if progressive worsening 1
• Administer benzodiazepine: midazolam 0.05-0.1 mg/kg IV or diazepam 0.2 mg/kg IV for seizure control and anxiety 1
• Decontamination and removal from exposure source 1

Common Pitfalls to Avoid

• Do not delay intubation in patients with bulbar symptoms or descending paralysis, as respiratory failure can occur rapidly 1
• Do not assume facial paralysis means inability to experience respiratory distress, as facial muscle paralysis can mask signs of distress 1
• Do not delay corticosteroids beyond 72 hours in Bell's palsy, as effectiveness decreases significantly 2
• Do not use antiviral therapy alone for Bell's palsy; it is ineffective without corticosteroids 2
• Do not wait for laboratory confirmation before administering botulinum antitoxin if clinical suspicion is high 1
• Do not use succinylcholine for intubation in nerve agent poisoning; use rocuronium instead 1

Immediate Supportive Care Measures

• Monitor for urinary retention, constipation/ileus, dry mouth, and dry eyes 1
• Provide DVT prophylaxis for immobilized patients 1
• Ensure adequate hydration and nutrition 1
• Position patient to prevent aspiration if swallowing is impaired 1