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Guillain-Barre "Ground to Brain" (CLINICAL S/S:…
Guillain-Barre
"Ground to Brain"
ETIOLOGY
Autoimmune disease that causes an acute peripheral nervous system disorder that results in flaccid paralysis of the skeletal muscles and loss of muscle reflexes.
Autoimmune response due to foreign antigens (infectious agents) that attack the nerve tissues. Ex:
CMV
Demyelination and Inflammation
Onset occurs in 1 to 4 weeks after a febrile episode caused by mild resp or GI viral/bacterial infection.
More prominent in white s then blacks . Occurs in 1:100,000 individuals
DIFFERENTIAL DIAGNOSIS
Meningitis
Myasthenia Gravis
Muscular Dystrophy /ALS
RESPIRATORY MANAGEMENT
Airway protection
:VAP protocol
Oxygen Therapy Protocol
: SpO2 > 90%
Mechanical Ventilation Protocol
Bronchial Hygiene therapy Protocol
Measurements
: MIP, MEP, FVC
Lung Expansion Therapy Protocol
: IS/IPPB
Rehabilitation:
PT, OT, hydrotherapy. Process can take anywhere from a few weeks or as long as 3 years.
FVC < 20, MIP < -30, MEP < 40, PaCO2 >45, pH < 7.35 ............. Capillary shunting due to consolidation/atelectasis- PEEP needed
Immunotherapy:
Plasmapheresis, IVIG
DVT prophylaxis
- heparin
CLINICAL S/S:
Symmetrical weakness paired with parethesia (tingling, burning, shock-like sensations or abnormal sense of touch).
Pain: throbbing, aching in buttocks or legs
Numbness
Ascending paralysis- upward towards the arms, trunk, and face. (Peaks in 2 weeks)
Absent DTR
Difficult chewing, swallowing (dysphagia), and speaking (aphasia), decrease gag reflex
Anxiety (Due decreasing muscle activity- diaphragmatic excursion)
**Muscle weakness and paralysis can develop within a single day or several days
Tachypnea- varies with severity of muscle paralysis
Cyanosis
Diminished BS (Aveolar consolidation- with no fluid overload issue present)
Crackles(Atelectic airways)
Fever, malaise, nausea
Autonomic symptoms:
Tachycardia, bradycardia, HTN w/ hypotension, urinary retention (UTI/sepsis), loss of sweating, obstruction of ileus (necrotic bowel can insue due to lack of bowel movement).
PATHOPHYSIOLOGY
Mucous accumulation (we swallow 1L of fluid/day which will cause accumulation due to ineffective cough)
Airway Obstruction
Alveolar Consolidation
Atelectasis
Demyelination(breakdown of the myelin sheath by macrophages) inflammation and edema
Muscle weakness and paralysis (due to decreases nerve impulses)
DIAGNOSTIC TESTS
EMG/NCS
Spinal Tap
ABG
Show acute polyneuropathy with demyelinating or axonal characteristics
LABS
High serum antibody titers (early stage), elevated IgM, High AST/ALT
Clinical presentation/Hx
CXR:
: Normal unless aspiration and/or PNA present
Serology - viral/bacterial infection control
CSF: Elevated protein level 100 to 1000g/dL with a normal WBC
Dec pH , Inc PaCO2, Inc HCO3- , Dec PaO2, Dec SaO2
**Monitor pt due to high risk PNA