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Immediate stabilization
Time-critical threats
Respiratory failure
Rapidly progressive weakness within hours to days
Bulbar dysfunction
Weak cough or inability to clear secretions
Single breath count < 15
Autonomic instability
Bradyarrhythmia
Tachyarrhythmia
Labile blood pressure
Urinary retention
Mimic requiring immediate reversal
Myasthenic crisis
Botulism
Spinal cord compression
Airway and ventilation triggers
Bedside respiratory metrics
Forced vital capacity < 20 mL/kg
Negative inspiratory force weaker than -30 cm H2O
Peak cough flow low or absent
If any trigger present, escalate for airway control
Early critical care consultation
Avoid delay for imaging or lumbar puncture
Monitoring and access
Continuous telemetry
Ventricular ectopy
Sinus pauses
Noninvasive blood pressure frequent cycling
If labile, arterial line
Two large bore IV lines
If IVIg planned, infusion capable access
Early specialist activation
Neurology
Electrophysiology planning
Immunotherapy selection
Critical care
Ventilator planning
Dysautonomia management
Key decision points
Disease pattern confirmation
Progressive bilateral limb weakness
Symmetric more than asymmetric
Distal and proximal possible
Hyporeflexia or areflexia
Early preserved reflexes possible
Time course
Onset to nadir within 4 weeks
Immediate exclusions
If sensory level or sphincter early, spinal cord process
Urgent MRI spine
If fluctuating fatigable weakness, neuromuscular junction process
Bedside ice test if ptosis
Consider acetylcholine receptor testing later
Severity triage
ICU risk features
Rapid progression
Bulbar weakness
Dysautonomia
FVC < 20 mL/kg
Pitfalls
Early normal cerebrospinal fluid
Albuminocytologic dissociation may be absent in first week
Early normal nerve conduction study
Repeat study may be needed after 1 to 2 weeks
Steroids as monotherapy
No proven benefit in typical GBS
Succinylcholine use in paralysis
Hyperkalemia risk
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.