2: Neuro Emergencies Flashcards
Which mentation change(s) indicate brainstem involvement?
Stuporous & comatose
What are examples of systemic causes of mentation changes?
Toxins
Metabolic Issues
Cardiovascular Events
What is the treatment approach for mentation changes?
Correct Temp/metabolic derangements
Treat what you can at the moment (Toxin if applicable, blood pressure, etc)
Evaluate signs of increased ICP
Maintain CPP
Decrease ICP (Mannitol or Hypertonic, Craniectomy)
What are signs of increased ICP?
Cushing’s Effect
Pupil Changes
Proprioceptive/CN deficits
Decerebrate posture
What are the methods for decreasing ICP?
Decreasing edema: Mannitol or Hypertonic Saline
Increase space: Craniectomy or lesion removal
What clinical signs do you see with the Cushings’ Reflex?
Severe hypertension with reflex bradycardia
Definition of Status Epilepticus?
Failure of seizure to terminate
Any seizure lasting >5 min or >2 seizures without return to normal consciousness
What are some systemic effects of status epilepticus?
hypertension, tachycardia, arrhythmias, hyperglycemia, respiratory compromise, hyperthermia, acidosis, myoglobinuria
Death from status epilepticus is a result of which processes?
Brain herniation
Ventricular arrhythmias
Respiratory compromise
Renal failure (after days of myoglobinuria)
What is the immediate treatment for status epilepticus?
Check temperature & initiate active cooling, O2 supplementation,
Anti-Seizure Drugs:
Fast: Diazapam or Midazolam; 3 failed benzos-> anesthetic dose of propofol
Long: Phenobarb/Keppra
Why is it important to also start a long-acting seizure drug when treating status epilepticus?
Benzodiazepines only stay in the brain for ~5min.
Most patients will need a long term long acting anyway
What are the two major groups of etiologies of status epilepticus?
Reactive, Epileptic
What are two major causes of reactive status epilepticus?
Metabolic & Toxic
What are the three categories of epilepsy?
EUC
Idiopathic
Structural
The first step in treating a traumatic brain injury is determined by what factor?
Is the patient seizing?
If yes, stop seizure
If no, systemic eval