神经科急症.ppt

CT scan /MRI CSF Common Causes － － Metabolic disturbances ＋ － Stroke Tumor Abscess ＋/－ ＋ SAH Meningitis Encephalitis Structural disorders Blood glucose Complete blood count coagulation screen Electrolyte BUN Cr Liver function tests (esp. blood ammonia氨 level) Arterial blood gas analysis Chest X-ray Toxicology screen Blood, urine culture Parallel processes ABCs and the LOC An intravenous line Blood sample Pupils – mannitol (甘露醇) Find the cause treat it accordingly Supportive measures Nutritional support Caloric requirements Fluid volume Electrolytes Complications Aspiration (误吸) Impaired skin Contractures (挛缩) of joints Cushing triad (三联征) Headache Vomiting Papilloedema (视乳头水肿) Normal Cushings reflex Hypertension Bradycardia Other signs Level of consciousness Respiratory changes Diplopia (VI) 扣带回疝，大脑镰下疝 穿颅疝 颞叶钩回疝 小脑扁桃体疝 幕上 幕下 小脑幕切迹疝 Closely monitor Level of consciousness Pupils (size, equality, reaction to light) Vital signs ICP Closely monitor ICP Closely monitor ICP Osmotic Diuretics (渗透性利尿剂) Mannitol (甘露醇) is the most effective Furosemide (速尿) Glycerol (甘油) Hypothermia CSF drainage Decompressive craniotomy (去骨瓣减压术) Not in chinese text book, initially-non-neurologists Alternate Priority, abbreviated,stable,p1881 Vomit, snore Roll casualty on side2. Tilt the head backwardscheck and clear mouth Roll casualty on side2. Tilt the head backwardscheck and clear mouth Roll casualty on side2. Tilt the head backwardscheck and clear mouth p1880 p1880 p1888 p385 p385 p385 Frequently occur Rapidly assess Accurate diagnosis Effectively manage Severe permanent sequelae (后遗症) Primary: initial structural damage upon injury Neurons Supporting tissues Blood vessels Stem cell offers hope Secondary: progressive cellular dysfunction ?hypoxia, hypotension, seizures, hyper-thermia, etc. Treatments ? lighten secondary injury As soon as possible ?irreversible Traditional examination doesn’t work. History ?PE ?DD ?Diagnostic tests ? Treatment Parallel processes a