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MACHS > Neuro > Flashcards

Neuro Flashcards

1
Q

guideline for seizures

A

NICE 2024 - revised

Management of epileptic seizure or management febrile seizure

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2
Q

Example medication seizures

A
  1. Lorazepam - 0.1mg/kg max 4
  2. Buccaneer - midazlam - only children
  3. Diazepam

if seizure over 15 minutes
1. IV levetiracetam 40mg/kg
2. IV phenytoin - 20mg/kg over 20 minutes

NICE revised 2022 - management epilepsy

Epilepsy - sodium valporate - NCIE 2022

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3
Q

Medication epilepsy

A

sodium valporate

NICE 2022

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4
Q

Priorities for seizures

A
  1. Environment - NHS 2023 - document length and symptoms - check identity cards - protect - cushion head, remove glasses - remove harmful objects - no retrain or in mouth
  2. Medication - more than 5 minutes or third in an hour 1. midazlam (children) (2. diazepam if prefered) 3. IV - lorazepam - sodium valporate
  3. medication over 15 minutes - levetiracetam and Phenytonin
  4. secure airway - intubate and ventilate
  5. reverse shock - fluid maintainance
  6. neuroprotect - therapy to prevent death or neural pathways
  7. Infusion of propofol until haemodnamically stable - anticonvolsant properties

NICE revised 2024 - Managing epileptic seizure

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5
Q

Symptoms of neuro deterioration

A
  1. hypoxia 0 ischamia
  2. hypotension (reduced perfusiono)
  3. hypertension (haemorrhage)
  4. cardiac dysrhymia - shock
  5. hyperthermia - blood flow and inflammation - increased metabolic demand
  6. raised ICP - alter GCS
  7. decrease sodium - cause oedema
  8. coagulation - haemorrhage
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6
Q

Reference neuro changes

A

NICE, 2019 - suspected neuro conditions

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7
Q

Symptoms of neuro changes

A
  1. altered consciousness
  2. decreased heart rate
  3. altered heart rhythms
  4. hypo/hypertensive
  5. temperture changes
  6. GCS changes
  7. pupil response or changed vision
  8. sudden onset headaches
  9. gait.balance changes
  10. muscle weakness and sensation changes
  11. nausea/vomiting
  12. photophobia
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8
Q

Priorities f neuro changes

A

NICE 2019

  1. Secure airway - O2 therapy
  2. Suction
  3. position - supine or side
  4. Investigations - ABG and cultures, ECG, CT, MRI
  5. medication for blood pressure - beta blockers and isotopes
  6. fluid balance - 0.9% saline - avoid dextrose and cause increased cerebral oedema increasing brains water content - visual swelling and cushing triad
  7. keep warm and monitor
  8. if pupils fixed give sodium chloride and mannitol
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9
Q

What is autonomic dryreflexia?

A
  • caused most commonly by distended bowel/bladder
  • a spinal cord lesion stopping noxious signals
  • cause massive sympathetic reflex
  • Causing widespread vasoconstriction of blood vessel
  • hypertension
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10
Q

Symptoms of autonomic dysreflexia

A
  1. raised BP
  2. bradycardia
  3. pounding headache
  4. flushing
  5. sweating
  6. blotching above level of injury
  7. pale
  8. cold
  9. goosebumps below injury level
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11
Q

Priorities autonomic dysreflexia

A
  1. sit up - to return BP to normal
  2. loosen or remove tight clothing
  3. monitor BP every 2-5 minute
  4. Check bowel - constipation, hamorrrhoids and bladder for catheter kinks and obstructions
  5. Insert catheter
  6. systolic BP over 150 - start 10mg nifedipine sublingual or chewed r GTN spray 1-2 sprays - repeat 2-=30 min

ROYAL NATIONAL ORTHOPAEDIAC HOSPITAL - 2019

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12
Q

Reference GCS

A

Teasdale and Jennett (1974)

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13
Q

Symptom Intracranial Pressure Raise

A

NICE 2019

  1. altered consciousness
  2. confusion
  3. restless
  4. lethargy
  5. Headache
  6. Pupillary dysfunction
  7. motor and sensory deficits
  8. cranial nerve palsy
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14
Q

Late signs and symptoms of raised intracranial pressure

A

NICE 2019

  1. loss of consciousness eg, comatose
  2. bilateral dilated and fixed pupils
  3. altered vital signs
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15
Q

Priorities of raised intracranial pressure

A
  1. upright midline position - fluid drainage
  2. O2 therapy
  3. vital signs and escalate as appropriate
  4. avoid hyperthermia - use paracetamol to reduce metabolic demand
    5, manage pain
  5. Fluid resus - 500ml - 100ml 1st 10kg - 50ml 2nd 10kg - NICE 2016
  6. IV mannitol and 3% saline if pupils fixed - not under 12 year old - BNFC 2023 - BNF 2024
  7. CT and MRI
  8. GCS every 30 minutes -Teasdale and Jeannette 1974
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16
Q

Pathophysiology of seizures

A
  • uncontrolled and rapid discharge action potential in neurones
  • prolonged neuro depolarisation
17
Q

priorities to manage a child having febrile seizure

A
  1. monitor duration
  2. environment - cushio head and remove harmful objects - do not restrain or put anything in mouth - when seizure stop put into recovery position
  3. NBM until recovered
  4. if more than 5 minutes - emergency benzodiazepine resus medication - option buccaneers midazolam or rectal diazepam

NICE revised 2024 - acute management febrile seizure

MACHS (6 decks)

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