07/01/2011 a 45 year old man, construction worker, came to the hospital with a drug and alcohol testing form, to be checked for drug and alcohol use because his employer sent him in. The employer states that for the past two weeks he has been stumbling around at work and loosing his balance and the employer thinks that he is using alcohol and or drugs at or before work. Patient denies any use of alcohol before work but does drink 4 to 5 beers after work each night at the bar with his co-workers. Pt. also denies any kind of drug use. Patient complains of muscle weakness and slight numbing in his toes. Admits to not being able to control his leg movements at times. Patient has currently recovered from mononucleosis three weeks ago. Pt. has no other history that relates to these conditions.
PHYSICAL EXAM:
Upon further examination his leg reflexes are slowed. At first his heart rate 92, respiratory rate 16 and blood pressure 137/87 are all with in normal range.Then his blood pressure began fluctuating.
BS- Clear throughout all lung fields, BP- 137/87, Temperature 37.9C. Patient walks with drop foot, and stumbles. Unable to wiggle toes. Patient not able to grasp objects firmly and drops them. HEENT normal. A Pulmonary function test is ordered.
SOAP:
S - Patient's employer states he has been stumbling around at work the past two weeks. Patient denies alcohol and drug use. Patient complains of muscle weakness and slight numbing in his toes. Patient has recovered from mononucleosis three weeks prior.
O -Upon examination patient showed lessened reflexes in the knees and pedal areas. Unable to wiggle toes, HR- 92, RR- 16, BS- Clear throughout all lung fields, BP- 137/87,but fluctuating. Temperature 37.9C. Patient walks with drop foot, and stumbles. Patient not able to grasp objects firmly and drops them. A PFT reveals a vital capacity of 1.5 liters and a maximum inspiratory pressure of -30 cmH2O.
A - Through discussion and observation of patient, there is weakened muscles and reflexes in lower extremities. Patient looks a little pale but otherwise healthy. Other than patient seeming apprehensive and nervous, all vitals except fluctuating B/P are normal. Patient does stumble and sway when walking and has drop foot and struggles to consciously pick up feet to walk. Patient also presents with hyperesthesia, an extreme sensitivity of one of the body's sense organs, such as pain or touch receptors in the skin.
P- The patient has been admitted into the hospital for observation and tests. Tests to be performed are: Lumbar puncture to withdraw and test CSF for an elevation of white cells and protein in the cerebrospinal spinal fluid (CSF) which strongly indicates a diagnosis of GBS. A computed tomography scan, and electromyogram studies to rule out all other possibilities. If results are positive for GBS, then treatment will include: focus on lessening the severity of the symptoms and accelerating recovery, intravenous immunoglobulin, plasma exchange and CSF filtration, and Consultation with CNS and Respiratory. Bedside spirometry will be done daily to monitor and verify vital capacity and maximum inspiratory pressure functions. There is no antibiotic for GBS and it just has to run its course. Anti-inflammatory drugs and narcotics as needed will help with pain. Patient will be placed on BiPAP and continuous pulse-ox and heart monitor.Respiratory will be on alert for any signs of respiratory dysfunction. Mechanical ventilation may be required if: BiPAP is not tolerated,complete paralysis occurs, the inability to clear secretions or ineffective swallow and gag reflex occurs.
QUESTIONS:
Treatment options for GBS focus on lessening the severity of the symptoms and accelerating recovery. Three main therapies are used to achieve this: What are the three main therapies?
What causes Giullain-Barre Syndrome? What are the major signs of the disease?
What makes this disease so deadly?
At what age does Guillain-Barre occur and what is usually a preceding sign of patients dianosed with GBS.
Guillain-Barre
Group Members:ADMITTING HISTORY:
07/01/2011 a 45 year old man, construction worker, came to the hospital with a drug and alcohol testing form, to be checked for drug and alcohol use because his employer sent him in. The employer states that for the past two weeks he has been stumbling around at work and loosing his balance and the employer thinks that he is using alcohol and or drugs at or before work. Patient denies any use of alcohol before work but does drink 4 to 5 beers after work each night at the bar with his co-workers. Pt. also denies any kind of drug use. Patient complains of muscle weakness and slight numbing in his toes. Admits to not being able to control his leg movements at times. Patient has currently recovered from mononucleosis three weeks ago. Pt. has no other history that relates to these conditions.
PHYSICAL EXAM:
Upon further examination his leg reflexes are slowed. At first his heart rate 92, respiratory rate 16 and blood pressure 137/87 are all with in normal range.Then his blood pressure began fluctuating.
BS- Clear throughout all lung fields, BP- 137/87, Temperature 37.9C. Patient walks with drop foot, and stumbles. Unable to wiggle toes. Patient not able to grasp objects firmly and drops them. HEENT normal. A Pulmonary function test is ordered.
SOAP:
S - Patient's employer states he has been stumbling around at work the past two weeks. Patient denies alcohol and drug use. Patient complains of muscle weakness and slight numbing in his toes. Patient has recovered from mononucleosis three weeks prior.
O - Upon examination patient showed lessened reflexes in the knees and pedal areas. Unable to wiggle toes, HR- 92, RR- 16, BS- Clear throughout all lung fields, BP- 137/87,but fluctuating. Temperature 37.9C. Patient walks with drop foot, and stumbles. Patient not able to grasp objects firmly and drops them. A PFT reveals a vital capacity of 1.5 liters and a maximum inspiratory pressure of -30 cmH2O.
A - Through discussion and observation of patient, there is weakened muscles and reflexes in lower extremities. Patient looks a little pale but otherwise healthy. Other than patient seeming apprehensive and nervous, all vitals except fluctuating B/P are normal. Patient does stumble and sway when walking and has drop foot and struggles to consciously pick up feet to walk. Patient also presents with hyperesthesia, an extreme sensitivity of one of the body's sense organs, such as pain or touch receptors in the skin.
P- The patient has been admitted into the hospital for observation and tests. Tests to be performed are: Lumbar puncture to withdraw and test CSF for an elevation of white cells and protein in the cerebrospinal spinal fluid (CSF) which strongly indicates a diagnosis of GBS. A computed tomography scan, and electromyogram studies to rule out all other possibilities. If results are positive for GBS, then treatment will include: focus on lessening the severity of the symptoms and accelerating recovery, intravenous immunoglobulin, plasma exchange and CSF filtration, and Consultation with CNS and Respiratory. Bedside spirometry will be done daily to monitor and verify vital capacity and maximum inspiratory pressure functions. There is no antibiotic for GBS and it just has to run its course. Anti-inflammatory drugs and narcotics as needed will help with pain. Patient will be placed on BiPAP and continuous pulse-ox and heart monitor.Respiratory will be on alert for any signs of respiratory dysfunction. Mechanical ventilation may be required if: BiPAP is not tolerated,complete paralysis occurs, the inability to clear secretions or ineffective swallow and gag reflex occurs.
QUESTIONS:
Treatment options for GBS focus on lessening the severity of the symptoms and accelerating recovery. Three main therapies are used to achieve this: What are the three main therapies?