Bilateral Diaphragm Paralysis case Flashcards

1
Q

What symptoms may a patient with phrenic palsy present with
What signs may a patient present with
-why does this happen

A

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
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2
Q

What are the potential causes of phrenic palsy?

VITAMIN CDEF

A

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
-

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3
Q

What would spirometry and lung function tests show
-use the LFT algorithm
What test would confirm the diagnosis

A

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

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4
Q

What would an ABG show
What would the Aa gradient show
How would you manage this case

A

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

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