Mr Gordon Chahar is a 53 year old gentleman who presented to A+E on 12 Dec with bilateral lower limb weakness which had been progressively deteriorating over one week causing difficulty climbing stairs and rising from a chair. He had no sensory symptoms, and neurological examination demonstrated symmetrical lower limb weakness and loss of lower limb reflexes. A lumbar puncture demonstrated raised protein, but all other indices were normal. He was diagnosed with Guillain-Barré syndrome and admitted under neurology where he received a course of treatment with intravenous immunoglobulin (IVIG) (You will learn more about Guillain-Barré syndrome and its treatment in the Neurocritical care course in year 2 of the MSc).
Critical care were contacted after 10 days of admission, as
Mr Chahar’s condition had deteriorated, and was now involving his upper limbs, with some facial nerve involvement also. It is decided to admit him to the intensive care unit. At the time of admission, Mr Chahar is still able to raise his head from the pillow, swallow safely, and speak in complete sentences. His FVC is 2.3L (predicted 3.9L).
You are asked to prescribe venous thromboembolism prophylaxis for Mr Chahar. What treatment(s) would you prescribe and why?
- Should we prescribe ulcer prophylaxis for Mr Chahar?
- How should we provide nutrition to Mr Chahar?
- Under what conditions would you consider an insulin infusion for Mr Chahar?
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