For acute, urgent and emergency care staff
As most people with MND are cared for at home, if an acute incident occurs, they will need to access crisis intervention services.
Our information for professionals in acute, urgent and emergency care is designed to give succinct guidance on actions to take and things to consider when treating someone with the condition.
Key points when you have a patient with MND
- Emergency healthcare plan
- Advance care plan – this includes preferences for care, including place of care and end of life decisions
- Advance Decision to Refuse Treatment (ADRT) – if the person has created and signed an ADRT, this must be considered
- Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) – the person may have specified a DNACPR, which must be considered
- MND Alert Card or Understanding My Needs – these include key contacts and information about their care team and the specialist help they may need.
However, this could be normal for that person. They will have a normal increased respiratory rate and also a lower Sp02 that needs to be taken into account. Establish if this has changed.
Find out how the person communicates. Speaking can be very difficult, or impossible, for people with MND. They may normally use a communication aid and should be helped to use this, if appropriate.
Patients with respiratory failure due to chronic neuromuscular weakness (seen in MND) will rapidly retain carbon dioxide. Supplementary oxygen therapy can have a serious detrimental effect in people with MND, reducing respiratory drive and worsening their condition.
Oxygen therapy (unless as a palliative measure, which may be appropriate) should be used with great caution in patients with MND-related respiratory problems and monitored by arterial blood gas analysis.
Seek guidance from the specialist palliative care team or a respiratory consultant with links to neurology.
This is due to decline of respiratory function in MND.
If airways are clear, reapply non-invasive ventilation (NIV) to treat breathlessness. Visit our pages on respiratory symptoms in MND for further information.
See our information on cognitive change.
Check full blood count (FBC) for signs of neutropenia and liver function tests (LFTs) for sign of disturbance, especially alanine transaminase (ALT).
If next of kin is not present, every attempt should be made to contact them in case crucial decisions need to be made. Once located, take account of their insight into the person’s condition and care needs.
This will affect decisions around administration of medication (including route and type) and fluids.
Especially if the patient has swallowing difficulties and no enteral feeding tube.
Where available, contact the specialist team in your hospital or local area. See details of MND Care Centres and Networks.