Bilateral Diaphragm Paralysis case Flashcards
What symptoms may a patient with phrenic palsy present with
What signs may a patient present with
-why does this happen
SOB
General muscle weakness
Orthopnea
Abdominal wall moves down when inspiring
- normally would move up
- when lying down, abdominal contents fall into the diaphragm but the diaphragm is unable to push back
- when inspiring, the diaphragm is unable to move against the -ve thoracic pressure
What are the potential causes of phrenic palsy?
VITAMIN CDEF
Iatrogenic/idiopathic
- sedative drugs
- surgery
Trauma
- head injury
- SC/phrenic injury affecting C3-5
Autoimmune
-Myasthenia gravis
Metabolic
-Pompes
Inflammatory/infective - Neoplastic - Congenital -DMD
Degenerative
- Disc prolapse => nerve root injury
- MND
- COPD
Functional
-
What would spirometry and lung function tests show
-use the LFT algorithm
What test would confirm the diagnosis
Peak flow
-low
FEV1, FVC
-low
FER
-normal or high => restrictive issue affecting lung volume (low TLC when lying down)
RV
-slightly high (requires more external force to push air out in expiration, so not a stiff lung issue)
TLCO, KCO
-normal => extrapulmonary cause interfering with lung expansion
If TLC measured when standing and lying, there should be a marked difference between the 2
What would an ABG show
What would the Aa gradient show
How would you manage this case
pH: normal
PO2: low, hypoxemia
PCO2: high, hypercapnia
HCO3: high, especially if this is chronic
Aa gradient likely to be normal
-not an issue with the alveolar capillary exchange surface
Type 2 resp failure => NIV