Page 173 - Critical Care Notes

4223_Tab05_141-174 29/08/14 8:28 AM Page 167

167
Clinical Presentation
■ Infection of the respiratory or GI tract 7–14 days before onset of neurologi-
cal symptoms
■ Symmetrical muscle weakness → flaccidity of muscle → symmetrical
ascending paralysis from the legs (hours or days) leading to upper limbs
and face with/without numbness or tingling
■ Loss of deep tendon reflexes (areflexia)
■ Difficulty with eye movements; double vision
■ Difficulty with swallowing; drooling; facial droop
■ Loss of pain and temperature sensation
■ Loss of proprioception (position sense)
■ Sinus tachycardia or bradycardia and cardiac dysrhythmias
■ Orthostatic hypotension; HTN
■ Absence of fever; excessive diaphoresis
■ Urinary retention common leading to UTI
■ Seizures
■ Bowel and bladder retention or incontinence
■ Decrease in vital capacity and negative inspiratory force → respiratory
failure/arrest
■ ↑ pulmonary secretions
■ ↑ protein in CSF (100–1,000 mg/dL)
■ SIADH
■ Residual damage possibly occurring after the acute phase
Diagnostic Tests
■ Lumbar puncture and CSF analysis
■ EMG and nerve conduction velocity studies
■ CBC, PFTs, and ABGs
■ Serum immunoglobulin
Management
■ Assess respiratory status and ABGs.
■ Provide early respiratory support, including mechanical ventilation with or
without tracheostomy.
■ Assess neurological function especially sensory and motor loss; start with
lower extremities. Assess LOC.
■ ECG and BP monitoring.
■ Administer propranolol (Inderal) to treat tachycardia and HTN and atropine
if bradycardia.

NEURO