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Respiratory Muscle Paralysis

Diaphragmatic Paralysis


Presentation

  • A 34-year-old lady presented with generalised weakness of body, indistinguishable from myasthenia gravis within 24 hours of a wasp sting.[ncbi.nlm.nih.gov]
  • In developing its educational products ATSDR has made a diligent effort to ensure the accuracy and the currency of the presented information.[atsdr.cdc.gov]
  • Presentation History Weakness : In 60% of cases, onset occurs approximately three weeks after a viral illness. The condition usually presents with an ascending pattern of progressive symmetrical weakness, starting in the lower extremities.[patient.info]
  • The clinical presentation appears as typical ascending flaccid paralysis. After aprodromal phase (paraesthesias, restlessness, irritaility, fatigue, and myalgias) neurological symptoms will start with paralysis of the lower extremities.[cvbd.org]
  • Congenital disorder of the brain related to paralysis is present in cerebral palsy.[health-tutor.com]
Fatigue
  • Physical effects The person may experience fatigue, poor balance, slurred words, a weak grip, tripping when walking, or other minor symptoms. Sometimes this stage occurs before a diagnosis is made.[mda.org]
  • After aprodromal phase (paraesthesias, restlessness, irritaility, fatigue, and myalgias) neurological symptoms will start with paralysis of the lower extremities. The deep tendon reflexes are weak or absent.[cvbd.org]
  • We have to make a clear distinction between muscle fatigue and muscle weakness. While fatigue is changing over rest, weakness is not.[shortnessofbreath.it]
  • . if you suspect that there is residual fatigue of the inspiratory muscles, take a day off. keep an IMT diary.[physio-pedia.com]
  • It is the principal muscle of respiration, is innervated by the phrenic nerves that arise from the nerve roots at C3 through C5, and is primarily composed of fatigue-resistant slow-twitch type I and fast-twitch type IIa myofibers. • What is the most characteristic[blogs.nejm.org]
Hypoxemia
  • Abstract Background Oxygenation is impaired in almost all subjects during anesthesia, and hypoxemia for shorter or longer periods is a common finding.[link.springer.com]
  • Do not wait for ABGs to show hypoxemia or hypercapnia. These are late developing signs that appear only immediately prior to respiratory arrest in MG patients.[myasthenia.org]
  • Acute respiratory distress syndrome (ARDS) is a lethal syndrome characterized by hypoxemia, bilateral infiltrates and diffuse alveolar damage.(1) Patients presenting with ARDS often require intubation and mechanical ventilation for hypoxemic respiratory[sccm.org]
Hypersomnia
  • Both the reduction in strength and endurance of the respiratory muscles are causing alteration of the sleep structure, primarily reducing quantity of rapid eye movement (REM) sleep hypersomnia.[shortnessofbreath.it]
Dyspnea
  • When symptomatic, the following may be noted : Difficulty breathing when physically active (exertional dyspnea). Reduced endurance. Mild orthopnea – difficulty breathing when lying down.[healthhype.com]
  • SDB often starts long before exertional dyspnea or orthopnea develop.[clinicaltrials.gov]
  • Dysfunction of one or both hemidiaphragms is an underdiagnosed cause of dyspnea.[blogs.nejm.org]
  • Shortness of breath on exertion (dyspnea) Need to sleep sitting up (orthopnea) Retention of carbon dioxide (CO 2 ) morning headaches poor concentration and impaired intellectual function Sleep disturbances not feeling rested in the morning sleepiness[gbppa.org]
  • NIV is also indicated prior to elective vertebral column correction surgery when VC 60% target value and FEV 1 40% target value, respectively, or during pregnancy with restricted lung function, as well as palliative care of dyspnea.[shortnessofbreath.it]
Headache
  • Poor respiration may cause fatigue, fuzzy thinking, headaches, and susceptibility to pneumonia. (Respiratory insufficiency is a leading cause of death in ALS.) Speech, or eating and drinking by mouth, may not be possible.[mda.org]
  • Bilateral Rapid shallow breathing Difficulty breathing even at rest Pronounced orthopnea Anxiety Disturbed sleep Fatigue Morning headache Clinical examination reveal absence of or severely dulled breathing sounds, inward movement of the abdomen when inhaling[healthhype.com]
  • . - Acute pain related to the adverse effect of spinal headache from epidural anesthesia. - Deficient knowledge related to lack of information about anesthesia. - Risk for injury related to the impact of any form of anesthesia on the CNS (CNS depression[quizlet.com]
  • […] some common signs that suggest you might have sleep apnea: Other people tell you that you stop breathing at night Loud snoring Restless sleep (especially if you awaken choking or gasping for air) Waking up with a sore and/or dry throat Waking with a headache[msktc.org]
  • Sleep study should be performed in the case of typical complaints such as headache, daytime sleepiness, nicturia, insomnia and changed cognitive function. 2.[shortnessofbreath.it]

Workup

Atelectasis
  • Causative mechanisms to atelectasis and airway closure seem to be loss of respiratory muscle tone and gas resorption.[link.springer.com]
  • A: Chest radiographs may reveal elevated hemidiaphragms and basal subsegmental atelectasis. Although chest radiography is a reasonably sensitive tool for detecting unilateral diaphragmatic paralysis (90%), its specificity is unacceptably low (44%).[blogs.nejm.org]
  • The buildup of mucus can result in atelectasis ((at-uh-LEK-tuh-sis), which is a collapse of all or a portion of the lung.[msktc.org]
  • On the other hand patients with reduced ability of cough are also at risk of developing pulmonary atelectasis and recidive pulmonary infection. Effective cough can only be produced with a MEP higher than 50–60 cm H 2 0 ( 4 ).[shortnessofbreath.it]
Hypercapnia
  • Validation has to be carried out with regard to both daytime hypercapnia and nocturnal retention of carbon dioxide because the latter often represents the earliest manifestation of respiratory muscle weakness.[clinicaltrials.gov]
  • Do not wait for ABGs to show hypoxemia or hypercapnia. These are late developing signs that appear only immediately prior to respiratory arrest in MG patients.[myasthenia.org]
  • At the first signs of nocturnal hypercapnia, the patient should be offered NIV therapy rather than waiting until the hypercapnia extends into the daytime period.[shortnessofbreath.it]
  • Instead, the CO 2 accumulates (called hypercapnia), and thus there is decreased room in the alveoli for oxygen. Hypercapnia and decreased oxygen saturation are the hallmarks of underventilation or hypoventilation.[gbppa.org]
  • […] exercised in the following events: history of spontaneous pneumothorax traumatic pneumothorax that has not fully healed burst eardrum or other conditions of the eardrum unstable asthma with abnormally low perception of dyspnoea Precautions Minimise hypercapnia[physio-pedia.com]

Treatment

  • […] well as training theory; 2) an understanding of how disease affects the respiratory muscles and the mechanics of breathing; 3) an insight into the disease-specific, evidence-based benefits of RMT; 4) advice on the application of RMT as a standalone treatment[books.google.com]
  • Botox treatments employ the purified and heavily diluted botulinum neurotoxin type A.[who.int]
  • Treatment Termination of the exposure including removing all soiled clothing. Gently cleanse with soap and water to hydrolyze organophosphate solutions. Airway control and adequate oxygenation.[openanesthesia.org]
  • All four patients responded well to treatment.[jpma.org.pk]
  • Treatment It is important to identify the cause of diaphragmatic paralysis and commence with the appropriate treatment as soon as possible. Treatment is not usually necessary with unilateral diaphragmatic paralysis (UDP).[healthhype.com]

Prognosis

  • A decrease to less than 20% of predicted normal is associated with a poorer prognosis.[patient.info]
  • A positive correlation exists between MIP and 6MWT, indicating that respiratory muscle training (RMT) can directly influence exercise tolerance in stroke survivors and contribute to better prognosis and survival.[pnmedical.com]

Etiology

  • Year introduced: 1973(1968) PubMed search builder options Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications congenital diagnosis diagnostic imaging drug therapy enzymology epidemiology etiology[ncbi.nlm.nih.gov]
  • The approach to the patient with hypokalemic paralysis includes a vigorous search for the underlying etiology and potassium replacement therapy. Further therapy depends on the etiology of the hypokalemia.[jpma.org.pk]
  • Etiology [ edit ] Cholinergic crisis, sometimes known by the mnemonic "SLUDGE syndrome", [2] can be a consequence of: Contamination with - or excessive exposure to - certain chemicals including: nerve agents, ( e.g. sarin, VX, Novichok agents ). organophosphorus[en.wikipedia.org]
  • A higher number of patients in the cisatracurium group had pneumonia as the primary etiology of ARDS, while those who received the placebo had more intra-abdominal sepsis as the source.[sccm.org]
  • It is considered significant when the distance between the surface of the anterior wall of the thorax and the deepest part of the depression is greater than 3 cm. 21 Its etiology is unknown, although a close relation to the Marfan syndrome has been found[archbronconeumol.org]

Epidemiology

  • Year introduced: 1973(1968) PubMed search builder options Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications congenital diagnosis diagnostic imaging drug therapy enzymology epidemiology[ncbi.nlm.nih.gov]
  • Epidemiology The incidence of typical GBS in Europe is 1.2-1.9 per 100,000 [ 3 ]. There is an increased incidence in males. Peak ages are 15-35 years and 50-75 years.[patient.info]
  • Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med. 2004;30:51-61. 2. Ranieri VM, Rubenfeld GD, Thompson BT, et al.[sccm.org]
Sex distribution
Age distribution

Pathophysiology

  • Following a brief examination of the force these muscles are required to exert in normal conditions, we review the pathophysiology of some characteristic alterations brought about by a) chest wall diseases such as kyphoscoliosis; b) other diseases involving[archbronconeumol.org]
  • Hypokalemic paralysis: A review of the etiologies, pathophysiology and therapy, Am. J. Emerg. Med., 1992; 10:143-8. 3. Gabow, P.A. Disorders associated with an altered anion gap. Kidney Int., 1985;27:472-483. 4. Battle, D. Renal tubular acidosis.[jpma.org.pk]

Prevention

  • Rothen HU, Sporre B, Engberg G, Wegenius G, Reber A, Hedenstierna G (1995) Prevention of atelectasis during general anesthesia. Lancet 345:1387–1391 PubMed CrossRef Google Scholar 52.[link.springer.com]
  • Prevention Prevention of foodborne botulism is based on good practice in food preparation particularly during heating/sterilization and hygiene.[who.int]
  • Prevention - Your first defense is to do whatever you can to prevent respiratory health problems. Here is a checklist. Do not smoke and stay away from secondhand smoke! Exposure to tobacco smoke is the worst thing you can do for your health.[msktc.org]
  • […] chemically induced classification complications congenital diagnosis diagnostic imaging drug therapy enzymology epidemiology etiology genetics history immunology metabolism microbiology mortality nursing parasitology pathology physiology physiopathology prevention[ncbi.nlm.nih.gov]
  • "They will give you enough pain medication to prevent you from feeling it" The nurse is administering an NMBD to a patient during a surgical procedure.[quizlet.com]

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