Medical Emergencies

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Medical Emergencies

• Central Nervous System

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Topics

• Pathophysiology
• Assessment
• Specific Topics
• Coma
• Seizures
• CVA

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Pathophysiology

• Structural Changes
• Circulatory Changes
• Alterations of ICP

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ICP Review

• CBF is a factor of CPP CVR
• CPP MAP - ICP
• MAP Diastolic 1/3 PP
• PP DBP - SBP
• PCO2 has greatest effect on CVR

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ICP Review

• As ICP ? CPP ?
• As PCO2 ? CVR ?
• As CVR ? CBF ?
• Normal ICP lt 15 mm Hg
• As ICP ? CBF ?
• Compensation for ? ICP via ? MAP
• Cushings Reflex

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Assessment of the Nervous System

• Goals
• Airway control/ maintenance
• Cardiovascular stabilization
• Interuption of cerebral injury
• Protection from further harm

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Primary Assessment

• Level of Consciousness
• Respiratory Insufficiency 2 to ? ICP?
• Adequate Ventilatory rate and depth?
• Posturing? Muscle Tone?
• Pupillary Reflexes?
• Extraocular Movements?

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Coma

• Abnormally deep state of unconsciousness without
  arousal
• Mechanisms
• Structural lesions
• Toxic Metabolic states
• Psychiatric mimicking

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Differentiating Cause of Coma

• Structural
• Asymmetrical deficits
• Unequal or unresponsive pupils
• Afebrile

• Toxic Metabolic
• Symmetric deficits
• Normaly responsive pupils
• Febrile

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Common Causes

• Alchohol or Acidosis
• Epilepsy
• Infection
• Overdose
• Uremia (renal failure)
• Trauma or Tumors
• Insulin (hypo- or hyperglycemia)
• Psychosis
• Stroke

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Management

• Attempt to differentiate cause
• Mainstays of therapy
• Oxygenation/Ventilation
• IV
• D50 (if hypoglycemic)
• Narcan
• Flumazenil in known benzo OD

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Seizures

• Alteration in behavior/consciousness 2 abnormal
  electrical activity
• Often a result of altered membrane permeability
• Generalized Seizures
• Petiti Mal
• Grand mal Seizures
• Partial Seizures

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Assessment

• History
• Duration
• Description
• Onset
• Typical for this patient?
• Head trauma?
• Fever? Headache?
• Medications?
• Compliant?

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Management

• Therapy Mainstays
• Oxygenation/Ventilation
• IV NS
• Valium, Ativan
• Glucose

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CVA

• Sudden interuption in blood flow
• Risk Factors
• Pathophysiology
• Thrombosis
• Embolus
• Hemorrhage
• TIAs

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Assessment

• History
• Previous CVA or TIA?
• Previous neuro deficits?
• Initial symptoms and progression?
• Altered LOC?
• Precipitating factors?
• Dizziness?
• Concomitant illnesses?

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Management

• Think brain attack
• MI of the brain
• Time is tissue
• Therapy Mainstays
• Oxygenation/Ventilation
• IV
• Differential
• Rapid Risk Assessment
• Rapid Transport