Neurological Emergencies

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Presentation to participants undertaking the: Critical Care Transition Program at ACT Health, 2008

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  • Meningitis can be caused by bacteria, viral or fungal infections. Today I will focus on bacterial meningitis as it is considered as a medical emergency and is also linked to Meningococcal. Untreated bacterial meningitis has a mortality rate of almost 100%. Even with antibiotic treatment the mortality rate is about 25% for adults. Organisms usually gain entry to the CNS through the upper resp tract or the blood stream or they enter directly from a penetrating head wound Usually occurs in autumn, winter and early spring secondary to viral respiratory tract infections at this time. Interesting to note that since the influenza vaccine was introduced in Australia there has been a drop in the rate of meningitis.
  • One of the physically demonstrable symptoms of meningitis is Brudzinski's sign. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.
  • Meningococcal caused by bacteria not virus Transmitted by sneezing, coughing kissing, and sharing food or drinks. Bacteria can live harmlessly in our throat and nose There are many strains of Meningococcal but in Australia the most common strains are B & C
  • a rash, which may start off as a spot, scratch mark or blister, as a faint pink rash or as red or purple pinpricks on the skin, then develop into the distinctive purple bruising.
  • The appearance of the distinctive rash is often one of the final symptoms of deadly meningococcal septicaemia & means that immediate medical treatment is vital. However, don’t assume that because there’s no rash, there’s no urgency. In fact, you may not see a rash at all – and if you wait until you do, it may well be too late to stop the progress of the disease. The rash is caused by bacteria multiplying in the blood vessels, and releasing toxins. These damage the blood vessels, so the blood can leak through into the tissues underneath the skin. The victim can literally bleed to death if not treated in time. It can start off either as a pink rash, or as tiny red or purple blood spots, like pin-pricks, anywhere on the body – which rapidly spread into purple blotches or bruises.
  • Time between picking up the disease and showing symptoms is 2-7 days
  • Neurological Emergencies

    1. 1. Jamie Ranse : Critical Care Education Coordinator, Staff Development Unit, ACT Health. Neurological Emergencies: Meningitis
    2. 2. definition <ul><li>An acute inflammation of the Pia mater and the arachnoid membrane surrounding the brain and spinal cord. </li></ul>
    3. 3. signs and symptoms <ul><li>Common </li></ul><ul><li>Malaise </li></ul><ul><li>Fever </li></ul><ul><li>Mild to severe headache </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Stiff or painful neck </li></ul><ul><li>Less common </li></ul><ul><li>+’ve Kernig’s sign </li></ul><ul><li>+’ve Brudzinski sign </li></ul><ul><li>Photophobia </li></ul><ul><li>Seizures </li></ul><ul><li>Decreased LOC/ coma </li></ul>
    4. 4. signs and symptoms
    5. 5. management <ul><li>Regular GCS to assess LOC </li></ul><ul><li>Regular Observations </li></ul><ul><li>Provide quiet, dark room </li></ul><ul><li>Provide analgesia </li></ul>
    6. 6. Jamie Ranse : Critical Care Education Coordinator, Staff Development Unit, ACT Health. Neurological Emergencies: Meningococcal Disease
    7. 7. overview <ul><li>Incidence </li></ul><ul><li>Signs and symptoms </li></ul><ul><li>Management </li></ul>
    8. 8. incidence <ul><li>Caused by the bacteria Neisseria meningitidis </li></ul><ul><li>Transmitted by saliva </li></ul><ul><li>Approx 20% of people will carry the bacteria without becoming affected </li></ul><ul><li>Short life span outside of body </li></ul><ul><li>Common strains are B & C </li></ul>
    9. 9. signs and symptoms <ul><li>Malaise </li></ul><ul><li>Fever </li></ul><ul><li>Mild to severe headache </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Stiff or painful neck </li></ul><ul><li>Photophobia </li></ul><ul><li>Pain in muscles and joints </li></ul><ul><li>Tachypnoea </li></ul><ul><li>Rash </li></ul><ul><li>Pain in chest or abdomen </li></ul>
    10. 10. signs and symptoms: rash <ul><li>Caused by bacteria releasing toxins which damage blood vessels. </li></ul><ul><li>Blood leaks into the tissues and underneath the skin </li></ul><ul><li>Patients can bleed to death if left untreated </li></ul>
    11. 11. management: incubation <ul><li>2-7 days </li></ul><ul><li>Treatment required for anyone who has had close contact within 7 days </li></ul><ul><li>Once treated they are not contagious </li></ul>
    12. 12. management <ul><li>Regular GCS to assess LOC </li></ul><ul><li>Regular Observations </li></ul><ul><li>Provide quiet, dark room </li></ul><ul><li>Provide analgesia </li></ul><ul><li>Invasive support for septicaemia </li></ul><ul><ul><li>Ventilation </li></ul></ul><ul><ul><li>Inotropes </li></ul></ul><ul><ul><li>Wound care </li></ul></ul>

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