神经病学华中科技大学.ppt

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 at different levels of patient management are required. Treatment PE Diagnostic tests DD History AIRWAY BREATHING CIRCULATION Neurological status Level of consciousness Pupils Patent (通畅的) Common causes Vomitus (呕吐物) Tongue obstruction Procedures Check and clear mouth (suction,抽吸) Positioning intubation (插管) Procedures Check and clear mouth Procedures Positioning (head-tilt, chin-lift) Procedures Intubation Monitor oxygen saturation Supplemental oxygenation ECG Heart rate cardiac rhythm Blood pressure Complete blood count Blood glucose Electrolyte BUN Cr The most sensitive indicator Definitions: Drowsiness (嗜睡) Stupor (昏睡) Coma Confusion (意识模糊) AVPU GCS Pitfalls Alert Verbal Stimulus Response Painful Stimulus Response Unresponsive Eye opening Best verbal response Best motor response Decorticate (去皮层) posturing Decerebrate (去大脑) posturing Interpretation Persistent vegetative state Locked-in syndrome Psychomotor inhibition (e.g. flexibilitas cerea 蜡样屈曲) Coma Increased intracranial pressure Myasthenic crisis Stroke/TIA Seizure status epilepticus SAH Meningitis Encephalitis ＋ ＋/－ Stroke Tumor Abscess － ＋ Metabolic disturbances － － Common Causes CSF CT scan /MRI 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 intrave