CEN7_Neurological Endocrine

NEUROLOGICAL EMERGENCIES Objectives: At the completion of this section, the learner will be able to:  Differentiate between early and late signs of increased intracranial pressure  Discuss care of the patient with a basilar skull fracture  Define autonomic dysreflexia  Recognize medications used in the treatment of seizures  Verbalize discharge instructions that should be provided to patients with Myasthenia Gravis The CEN exam contains fifteen questions on neurological emergencies which involve the following topics:  Alzheimer’s Disease/Dementia  Chronic Neurological Disorders (e.g. Multiple Sclerosis, Myasthenia Gravis)  Guillain-Barre Syndrome  Headache (including temporal arteritis, migraine)  Increased intracranial pressure  Meningitis  Seizure disorders  Shunt Dysfunctions  Spinal cord injuries  Stroke (e.g. Ischemic or hemorrhagic)  Transient Ischemic attack (TIA)  Trauma  Increased intracranial pressure (ICP)  Cranial Vault consists of three constituents: brain, cerebral spinal fluid (CSF) and blood.  Normal ICP: 0 - 15 mm Hg  Elevated ICP: > 20 mm Hg  Extremely high ICP may lead to herniation of the brain.  Clinical Manifestations of increased intracranial pressure: EARLY SIGNS (Increased ICP) LATE SIGNS (Herniation) Level of Consciousness More stimulation required to get same response Arousable only with deep pain or unarousable Pupils Sluggish response to light Fixed or dilated Motor Function Loss of one or more grades on the strength scale Posturing or no response Vital Signs Tachycardia, hypertensive swings Cushing’s response  Treatment  Reduce ICP by reducing the constituents of the skull: