Introduction: Flaccid paralysis is a cause of consultation in emergency services, with different etiologies, it can be immune-mediated or secondary to systemic diseases, which can lead to quadriparesis and ventilatory failure due to bulbar paralysis. Objective: To review the initial approach to flaccid paralysis due to neurological syndromes, the pathophysiology, clinical manifestations, diagnosis and treatment of the neurological diseases that make up this entity. Methods: a critical review of the scientific literature was carried out in MEDLINE, PUBMED, ELSEVIER, SCIENCE DIRECT, filtering results from subject reviews, case reports, cross-sectional studies, controlled clinical trials, meta-analysis and management guidelines with a total of 13934 documents, prioritizing 30. Results: The main cause of flaccid paralysis is Guillain barre syndrome, followed by systemic diseases and other neurological diseases such as myasthenia gravis or transverse myelitis, signs of respiratory failure must be identified early, diagnosis It is mainly clinical, although there are confirmatory studies, and treatment must be started early and in a timely manner with steroids, immunoglobulin or plasmapheresis, and immunomodulation. Conclusion: Flaccid paralysis is a neurological emergency with different etiologies, warning signs must be recognized, an initial approach and early clinical diagnosis must be carried out to initiate timely treatment.