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Vital capacity
60%
3/5
Chest expansion
0%
0/5
FEV1/FVC ratio
Serial arterial blood gases
20%
1/5
Tidal volume
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The symmetrical weakness/numbness progressing up the lower extremities following a GI illness is classic for Guillain-Barre Syndrome (GBS). Since respiratory failure is common in GBS patients, vigilance is essential. Respiratory monitoring is best done with bedside vital capacity. GBS is an acute, rapidly progressive immune-mediated polyneuropathy with weakness/paralysis that typically begins symmetrically in the lower extremities, spreads superiorly, and may involve the arms, chest, and cranial nerves. GSB may be preceded by a respiratory or GI infection (classically, Campylobacter jejuni). Clinical diagnosis can be confirmed with a lumbar puncture, which will show increased protein but normal white blood cell count (albumino-cytologic dissociation). As Walling and Dickson note, plasma exchange therapy can improve outcomes and IV Ig can hasten recovery in patients with GBS. Corticosteroids, however, have not been shown to have benefit. As Hughes et al. note, respiratory failure is common in GBS and up to 1/3 of patients develop severe distress requiring mechanical ventilation. Given this, close respiratory monitoring is recommended for every patient initially. This should be accomplished with vital capacity. Illustration A depicts the lung volumes and capacities, showing how the vital capacity is measured. Incorrect answers: Answers 2, 3, 4, & 5: Chest expansion, FEV1/FVC, arterial blood gases, and tidal volumes are not as effective or efficient as bedside vital capacity in assessing progression of reparatory paralysis.
4.3
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