Management of Suspected Guillain-Barré Syndrome - Flowchart
Management of Suspected Guillain-Barré Syndrome - Flowchart Management of Suspected Guillain-Barre Syndrome Management of Suspected Guillain-Barre Syndrome
Flowchart

Suspected GBS
(Typically post-infectious, progressive, ascending, symmetrical weakness with areflexia)

Suspected GBS
(Typically post-infectious, progressive, ascending, symmetrical weakness with areflexia)

Suspected GBS
(Typically post-infectious, progressive, ascending, symmetrical weakness with areflexia)


Discuss with ICU

Discuss with ICU

Discuss with ICU

End

End

End

Assess and stabilize airway, breathing and circulation.
Check viral capacity.

Assess and stabilize airway, breathing and circulation.
Check viral capacity.

Assess and stabilize airway, breathing and circulation.
Check viral capacity.


VC < 1.5 L or < 20 mL/kg or < 50% predicted

VC < 1.5 L or < 20 mL/kg or < 50% predicted

VC < 1.5 L or < 20 mL/kg or < 50% predicted

Yes

Yes

Yes

No

No

No

Obtain further history and perform examination as detailed in text

Obtain further history and perform examination as detailed in text

Obtain further history and perform examination as detailed in text

Arrange other investigations as detailed in text.

Arrange other investigations as detailed in text.

Arrange other investigations as detailed in text.

Urgent MRI spine

Urgent MRI spine

Urgent MRI spine

Spinal cord or cauda equina pathology possible?

Spinal cord or cauda equina pathology possible?

Spinal cord or cauda equina pathology possible?

Yes

Yes

Yes

No

No

No

Manage as appropriate
(see also Spinal Cord Compression Chapter 70)

Manage as appropriate
(see also Spinal Cord Compression Chapter 70)

Manage as appropriate
(see also Spinal Cord Compression Chapter 70)


Spinal Cord Compression Chapter 70

Non-GBS diagnosis confirmed?

Non-GBS diagnosis confirmed?

Non-GBS diagnosis confirmed?

Yes

Yes

Yes

No

No

No

Treat and investigate as appropriate (see Endocrine/Metabolic emergencies Chapters 81, 82, 83, 84, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94)

Treat and investigate as appropriate (see Endocrine/Metabolic emergencies Chapters 81, 82, 83, 84, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94)

Treat and investigate as appropriate (see Endocrine/Metabolic emergencies Chapters 81, 82, 83, 84, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94)

81 82 83 84 84 85 86 87 88 89 90 91 92 93 94

Severe biochemical derangement?

Severe biochemical derangement?

Severe biochemical derangement?

Yes

Yes

Yes

No

No

No

Consider investigations to support diagnosis (NCS, LP, serology)

Consider investigations to support diagnosis (NCS, LP, serology)

Consider investigations to support diagnosis (NCS, LP, serology)

Consider further investigations and other causes as appropriate (see text)
Revisit history and examination if needed

Consider further investigations and other causes as appropriate (see text)
Revisit history and examination if needed

Consider further investigations and other causes as appropriate (see text)
Revisit history and examination if needed


Is GBS the only tenable diagnosis?

Is GBS the only tenable diagnosis?

Is GBS the only tenable diagnosis?

Yes

Yes

Yes

No

No

No

Monitor vital capacity, cardiovascular function, power
Transfer to HDU/CU if severe weakness, respiratory compromise, autonomic disturbance, or rapid progression
Review analygesic requirement, thromboprophylaxis and swallow if not already done
Discuss with neurology - consider IVIg or plasma exchange (see text for further details)

Monitor vital capacity, cardiovascular function, power
Transfer to HDU/CU if severe weakness, respiratory compromise, autonomic disturbance, or rapid progression
Review analygesic requirement, thromboprophylaxis and swallow if not already done
Discuss with neurology - consider IVIg or plasma exchange (see text for further details)

Monitor vital capacity, cardiovascular function, power
Transfer to HDU/CU if severe weakness, respiratory compromise, autonomic disturbance, or rapid progression
Review analygesic requirement, thromboprophylaxis and swallow if not already done
Discuss with neurology - consider IVIg or plasma exchange (see text for further details)




GBS diagnosis made?

GBS diagnosis made?

GBS diagnosis made?

Yes

Yes

Yes

No

No

No

Therapy, monitoring and follow up as directed by diagnosis

Therapy, monitoring and follow up as directed by diagnosis

Therapy, monitoring and follow up as directed by diagnosis

Alternative diagnosis made?

Alternative diagnosis made?

Alternative diagnosis made?

Yes

Yes

Yes

No

No

No