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Guillain-Barre syndrome with respiratory weakness — ACEM Fellowship MCQ

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HardNeurological emergenciesGuillain-Barre syndrome with respiratory weaknessACEM Fellowship

A 15-year-old has rapidly ascending symmetrical weakness and areflexia after gastroenteritis. Oxygen saturation is 98% and the chest is clear, but the voice is becoming weak. Which bedside assessment is most important to trend while intensive-care support is arranged?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Measure serial vital capacity, cough strength and bulbar function

The best answer is “Measure serial vital capacity, cough strength and bulbar function”. Guillain–Barré syndrome can cause rapidly progressive respiratory muscle and bulbar weakness before oxygen saturation falls. Serial vital capacity, cough and bulbar assessment detect declining ventilatory reserve and guide early airway planning. Pulse oximetry may remain normal until late; electrodiagnostic confirmation and outpatient testing must not delay monitored escalation in progressive disease.

Reference: Royal Children’s Hospital Melbourne: Paediatric intensive-care clinical guideline—Guillain–Barré syndrome: https://www.rch.org.au/uploadedFiles/Main/Content/picu/PICU%20Guidelines%20final%20December%206%202017.pdf