How should patients with Guillain-Barre syndrome (GBS) be managed in the emergency department (ED)?

Updated: May 04, 2018
  • Author: Michael T Andary, MD, MS; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

In the emergency department (ED), continuation of ABCs, intravenous treatment, oxygen, and assisted ventilation may be indicated. [108] Intubation should be performed on patients who develop any degree of respiratory failure. Clinical indicators for intubation in the ED include the following:

  • Hypoxia

  • Rapidly declining respiratory function

  • Poor or weak cough

  • Suspected aspiration

Typically, intubation is indicated when the forced vital capacity (FVC) is less than 15 mL/kg. [109] Declining NIF to -30 cm water should cause concern and very close monitoring. [110]

Patients should be monitored closely for changes in blood pressure, heart rate, and arrhythmias. Treatment is rarely needed for tachycardia. Atropine is recommended for symptomatic bradycardia.

Because of the lability of dysautonomia, hypertension is best treated with short-acting agents, such as a short-acting beta blocker or nitroprusside. Hypotension from dysautonomia usually responds to intravenous fluids and supine positioning. Temporary pacing may be required for patients with second- and third-degree heart block.

Consult a neurologist if any uncertainty exists as to the diagnosis. Consult the ICU team for evaluation of need for admission to the unit.


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