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At bedside, a stable-looking patient can become an airway emergency. Fluctuating, fatigable ptosis, dysarthria, dysphagia, or limb weakness, with preserved sensation, points toward myasthenia gravis. Check function, not just numbers. Ask about swallowing and orthopnea; test cough, count a breath, and trend NIF/FVC with work of breathing. Weak cough, a falling count, or worsening bulbar function means danger. The trap: normal oxygen saturation does not exclude impending myasthenic crisis-especially early or with supplemental oxygen. Confirm with an AChR antibody; if negative or atypical, consider MuSK testing or electrodiagnostics. Search for infection, surgery, medication changes, and drugs that impair transmission. If the ward patient is worsening, call neurology and critical care early, repeat respiratory assessments, and consider IVIG or plasma exchange; ventilatory support depends on trajectory and airway protection. Treat worsening bulbar or respiratory weakness as crisis until proven otherwise. Follow function and trajectory-not saturation alone.