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GULLAIN-BARRE (CLINICAL SIGNS AND SYMPTOMS (history of recent febrile…
GULLAIN-BARRE
CLINICAL SIGNS AND SYMPTOMS
history of recent febrile illness
rapidly progressing
ascending
symmetrical muscle weakness/paralysis
sensory dysesthesias (pain or discomfort to touch)
decreased/absent deep tendon reflexes
dysautonomia (fluctuation in BP)
dysphagia (difficulty swallowing)
loss of gag reflex
dyspnea, progressing to respiratory insufficiency
DIAGNOSTIC TESTS
lunar puncture test to gather cerebral spinal fluid
increased protein
low WBC
EMG/NCS
slowing or blockage of nerve conduction
antibody tests
inc antiganglioside antibodies
liver enzymes
inc AST, ALT
serology
positive for C jejune or CMV
spirometry
dec VC, MIP/NIF, MEP
RESPIRATORY MANAGEMENT
intubation/mechanical ventilation
VC <1.0 L or >15mL/kg
MIP/NIF <-25 cmH2O, MEP <40 cm H2O
inability to cough, swallow, protect airway
ABG evidence of respiratory failure
aspiration pneumonia with severe hypoxemia
IV immunoglobulin therapy
implement VC, NIF monitoring Q8h
rehab with recovery
O2 therapy
SPO2 > 90%
infection control
DIFFERENTIAL DIAGNOSIS
botulism
lyme disease
MS
heavy metal toxicity
MG
ETIOLOGY
following viral/bacterial infection
Campylobactor jejuni
cytomegalovirus
following certain immunizations
PATHOPHYSIOLOGY
acute inflammatory neuropathy
spinal root
peripheral nerves
inflammation destroys the myelin sheaths surrounding the nerves
Lisa Stevenson