Neurological Conditions

Question 1

Red flag conditions associated with an altered level of consciousness:

Answer 1

Stroke/TIA

Head injury

Epilepsy

Hypoglycaemia

Hyperglycaemia

Subarachnoid Haemorrhage

Overdose

Question 2

What could cause a decreased level of consciousness?

Answer 2

Alterations to patients oxygen levels

Inadequate perfusion: hypovolaemia, arrhythmias, shock, syncope

Altered metabolic states

Intoxication or poisoning

Medical conditions: stroke, subarachnoid, epilepsy, meningitis, hypothermia

Head injury

Question 3

What are the red flags for a headache?

Answer 3

Sudden, thunderclap onset

Localised to the vertex (top)

Escalating headache of unusual nature

Changed visual acuity

Meningeal irritation

Changed mental state or behaviour

New ataxia

Cranial nerve palsy

Posture related headaches

Headache triggered by cough/ valsalva manoeuvre

Question 4

What is your management for a patient with suspected meningitis?

Answer 4

Classic signs: neck stiffness, photophobia, haemorrhagic rash

If there is a rash present, administer Benzylpenicillin IV unless there is a history of anaphylaxis.

Undertake an urgent transfer to nearest ED. Provide pre-alert

Question 5

What is your management for patients who are convulsing?

Answer 5

ABCDE- give O2. Consider NP airway.
Get full observations to determine cause

Position the patient for comfort and safety

Give diazepam for patients who are:
•Fitting for longer that 5 mins and still fitting
•Repeated fits in close succession - not secondary to hypoxia or hypoglycaemia
•status epilepticus
•eclamptic fits lasting >2-3 minutes

Question 6

What is your management for a stroke or TIA?

Answer 6

ABCDE- specifically assess glucose level.

Consider recording a 12-lead ECG but do not delay transport to ED.

IV access is not essential unless the patient requires specific interventions.