Neuro - Neurological emergencies Flashcards
Def status epilepticus
Life-threatening neuro condition - 5 or more mins of either continuous seizure activity or seizure activity w/o gaining consciousness
RF status epilepticus (4)
Non-adherence to anticonvulsant Dx
Chronic alcoholism
Refractory epilepsy
Toxic/metabolic causes
1st step Mx status epilepticus
A-E High flow O2 BM Temp Establish Hx /collateral Hx IV access
2nd step Mx status epilepticus
After 5 mins
Buccal midazolam or IV lorazepam
3rd step Mx status epilepticus
After another 10 mins - give 2nd dose of benzos
Make sure anaesthatist has been called
4th step Mx status epilepticus
IV phenytoin 18mg/kg
Max = 50mg /min
Acute causes of NM ventilatory compromise
GBS
Myasthenic crisis
Chronic causes of NM ventilatory compromise
MND
Myotonic dystrophy
Sx NM ventilatory compromise (7)
Resp failure Weak cough Paradoxical diaphragm movement Breathless when flat Use of accessory mm Incr RR Can't clear secretions
Bedside Ix NM ventilatory compromise (2)
VITAL CAPACITY!!!
ABG
ABG results acute NM ventilatory compromise
pH <7.35
PO2 <8
PCO2 >6
Bicarb = low/norm
ABG results chronic NM ventilatory compromise
pH norm
PCO2 >6
Bicarb >26mmol/L
What is a primary traumatic brain injury
Immediate result of trauma
What is a secondary traumatic brain injury
From complications of the trauma
I.e. hypoxia, ischaemia, haematoma
Def concussion
Transient LOC but no persistent neuro signs
Features of concussion
Temporary confusion/amnesia
PS diffuse axonal injury
Decr [ ]/memory
Personality change
Mx diffuse axonal injury
Supportive
2 types of damage in focal brain injury
Coup + counter-coup
What is post-concussion syndrome
Dizziness
Headache
Decr [ ]/memory
Mx post-concussion syndrome
Physio + OT helps
Assessment of someone with suspected head injury
C-Spine A-E Record GCS Hx if conscious Check for signs incr ICP Imaging - CT/C spineXR
Signs of declining neurological status after head injury (5)
Decr in GCS Pupil changes Development of focal signs Change in resp rate Cushings sign - decr pulse but incr BP
Why does Cushings signs occur?
Pressure on medulla oblongata
Bilateral pupil changes after head injury signify
Pre-terminal
Who must have a CT head within an hour? (7)
If GCS <13 on admission or <15 at 2hrs Focal neuro deficit Incr ICP Suspected skull # Post-trauma seizure Vom >1
Who must have CT head within 8hrs (4)
Anti-coag'd LOC + : \+65 y/o Dangerous mechanism Retrograde amnesia >30 mins before injury
Which bone is involved in a posterior fossa fracture?
Temporal bone