SCI, TBI, Status Epilepticus, Meningitis

c-spine injury precautions

• avoid and treat hypotension

• avoid hypoxemia (keep O2 >94%)

• intubate if necessary with paralytics and sedation

when do you intubate?

• poor oxygenation

• poor ventilation (high CO2 or decreased RR)

• inability to protect airway (altered MS, ineffective cough reflext)

• anticipated instability such as OR or procedures

what type of injury causes respiratory arrest?

injuries of C1-C3

C3-C5 injuries

• loss of diaphragm muscle strength to breathe

• hypoventilation

• weak cough

• aspiration of secretions

treatment of spinal cord injury

surgical decompression of spinal cord

neurogenic shock

• autonomic nervous system is damaged → loss of sympathetic tone and widespread vasodilation

• spinal cord injury above C6 can lead to neurogenic shock

• the higher the injury the more severe the shock

neurogenic shock s/s

• hypotension

• warm dry skin

• bradycardia

neurogenic shock treatment

administer norepi

what to avoid with TBI’s

• avoid hypoxia - goal is O2 >94%

• avoid hyperventilation d/t reducing blood flow to brain - exception is if there are signs of brain herniation

brain herniation

• life-threatening emergency where increased pressure inside the skull forces brain tissue to shift from its normal position across rigid structures

• consequence of brain edema or bleeding

brain herniation s/s

• dilated non reactive pupils

• extensor posturing

• progressive decline in neuro exam (decrease GCS score >2)

• cushings response (HTN, bradycardia, irregular respiration)

brain herniation and high ICP interventions

• preferred: hyperosmolar therapy

• transient hyperventilation

hyperosmolar therapy

• mannitol or hypertonic saline (HTS)

• act by fluid shift from intracellular to the extracellular compartment thus decreasing brain water content and ICP

status epilepticus

prolonged or rapidly occurring convulsions >5 mins

status epilepticus way to diagnose

EEG

first line treatment for status epilepticus

benzodiazepine

meningitis

inflammation of meninges

gold standard way to diagnose meningitis

lumbar puncture and CT scan

meningitis s/s

• fever

• stiff neck

• AMS

• petechial rash

• n/v

• coma

• focal neurological deficits

kernig sign

knee and hip is flexed to 90 degrees → extension of knee is painful or limited in extension

brudzinski sign

passive flexion of neck elicits hip and knee flexion

meningitis treatment

• antibiotics

  • ceftriaxone

  • vancomycin cefotaxemine/ampicillin

  • cefepime

  • meropenem

• steroids 10-20 min BEFORE abx OR give up to 4 hours AFTER abx