Gullain Barre Flashcards
Define guillain barre
A group of acute immune mediated polyneuropathies that generate an acquired weakness often following infection that may be complicated by respiratory failure or autonomic dysfunction
Define polyneuropathy
Polyneuropathy is damage or disease affecting peripheral nerves (peripheral neuropathy) in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain
Define autonomic dysfunction
Autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly
Why can gullain barre be difficult to diagnose?
Its very rare
Sometimes patients have variant symptoms
Sometimes paralysis moves in opposite direction it traditionally does
What is the leading subtype of gullain barre?
Acute inflammatory demyelinating polyneuropathy (AIDP)
What is meant by the term molecular mimicry in regards to gullain barre?
Antigens occasionally resemble proteins on host cells resulting in host antibodies attacking the host cells
What is the precursor infection that triggers most cases of GBS?
Campylobacter jenuni
What cells are attacked by the immune system in acute inflammatory demyelinating poly neuropathy?
Schwann cells
What do schwann cells do?
Produce myelin sheath around the axons that allow for the rapid conduction of nerve impulses
Why does the patient experience muscular weakness in GBS?
Muscles are fine, but the electrical impulses that are being sent are not reaching the muscles so they are unusable
What is the classic pattern of weakness displayed in GBS?
Weakness presents in an ascending pattern
Lower extremity weakness may present first
Ground to brain
What symptoms of GBS are concerning in regards to respiratory therapy?
Loss of ability to manage oral secretions
Weak cough, secretion accumulation
Respiratory muscle paralysis
Inability to protect airway (dysphagia)
What symptoms or history could lead you to suspect GBS?
Acute onset of mostly symmetrical muscle weakness
Absence of deep tendon reflexes
Symptoms progress over days to 4 weeks
Symptoms preceded by an infection
What are the diagnostic criteria required to diagnose GBS?
Progressive weakness of arms and/or legs ranging from minimal weakness in legs to total paralysis of all four limbs including trunk, bulbar and facial muscles
Decreased deep tendon reflexes in weak limbs
What supportive features would aid in a clinical diagnosis of GBS?
Symptom progression over days to 4 weeks
Relatively symmetric bilateral symptoms
Pain in trunk or limbs
Cranial nerve symptoms or signs
Mild sensory disfunction
No fever at onset
Elevated protein count in CSF
Recovery staring 2-4 weeks after progression halts
What might a patient with GBS present with at the bedside?
Variable respiratory rate based on degree of muscular paralysis
Possibly apnea
Cyanosis
What would the lungs of a patient with GBS potentially sound like?
Diminished
Crackles
What concerns might a patient with GBS raise?
Paresthesias (tingling, burning, electrical sensations)
Dysesthesias (upleasant sense of touch)
Pain
Numbness
Ascending muscle weakness
What problems would the autonomic nervous system dysfunctions cause?
Cardiac arythmias
Urinary retention
Alternating hypertension/hypotension
Ileus
Loss of sweating
What would the volumes and flows of a patient with GBS look like?
Decreased volumes and flows
What kind of lung pathology would a PFT reveal about a patient with GBS?
Restrictive
What testing would be performed on patients suspected of GBS to monitor their condition?
NIF
VC
What would the ABG of a patient with GBS look like?
Acute respiratory acidosis
Why would a spinal tap be administered to a patient with GBS?
Get tapped, loser
Check for elevated protein levels in CSF
Rule out competing diagnosis such as lyme or lymphoma
What would the CXR of a patient with GBS look like?
Normal
Maybe some atelectasis
What is the role of a respiratory therapist in treating GBS?
Oxygen therapy
Airway clearance
Lung expansion
Mechanical ventilation
When is mechanical ventilation indicated for GBS patients?
RR > 30
SpO2 < 92
FVC < 20
NIF < –30
Acute hypercapnia
Why is NIV not safe for patients with GBS?
Cant protect airway from secretions
What are the two disease modifying therapies available to GBS patients?
Intravenous immune globulin (IVIG)
Plasma exchange (PLEX)
Describe IVIG therapy
Patient is infused with healthy antibodies to replace damaged ones?
Describe PLEX therapy
Remove blood from the body and then separate the plasma out to remove the damaged antibodies
Blood is returned with added plasma or albumin
Why are steroids not used to treat GBS?
Studies show it doesnt work
What will most GBS patients need to full recover?
Physical therapy
Rehabilitation
