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This document provides information on altered levels of consciousness and related conditions. It defines terms like coma, persistent vegetative state, and levels of consciousness. It discusses the pathophysiology of altered consciousness, including disruptions to brain structures, neurotransmitters, and blood flow. Assessment tools like the Glasgow Coma Scale are mentioned. Medical management focuses on maintaining airway, circulation, and monitoring for complications like pneumonia or pressure ulcers. Nursing interventions include safety measures, stimulation, and meeting family needs.
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Alteration of consciousness can result from diminished alertness due to widespread brain abnormalities or reduced activity of the reticular activating system. Confusion is characterized by impaired attention/concentration and disorientation, while delirium involves additional symptoms like agitation, hallucinations, and convulsions. Levels of consciousness range from alert to comatose. Confusion can be caused by medical/surgical diseases, infections, drugs, or nervous system disorders and is evaluated through history, exam focusing on attentiveness/orientation, and controlling underlying illnesses. The Glasgow Coma Scale assesses eye, motor, and verbal responses to determine coma depth.
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2. Several types of seizures are defined, including absence seizures (petit mal), atonic seizures (drop attacks), clonic seizures, myoclonic seizures, tonic seizures, and tonic-clonic seizures (grand mal).
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Status epilepticus
1. Status epilepticus (SE) is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. SE can be convulsive or non-convulsive.
2. The annual incidence of SE is estimated to be between 9,000-14,000 new cases per year in the UK. Mortality is about 20-30% and is higher in the elderly.
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This document provides information on consciousness and coma:
- Consciousness has two components - arousal from the reticular activating system and awareness from the cerebral cortex. Stimulation of the RAS produces arousal while its destruction causes coma.
- The Glasgow Coma Scale and newer scales like FOUR are used to evaluate patients in comatose or reduced states of consciousness. The FOUR scale assesses eye, motor, brainstem, and respiratory responses.
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The document provides information about different types of seizures:
1. Status epilepticus is a condition where seizures continue for more than 30 minutes or seizures occur without recovery in between.
2. Several types of seizures are defined, including absence seizures (petit mal), atonic seizures (drop attacks), clonic seizures, myoclonic seizures, tonic seizures, and tonic-clonic seizures (grand mal).
3. Simple partial seizures can affect motor function, senses, autonomic functions, or thinking/emotions, while the person remains conscious. Complex partial seizures involve impaired consciousness in addition to symptoms.
Status epilepticus
1. Status epilepticus (SE) is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. SE can be convulsive or non-convulsive.
2. The annual incidence of SE is estimated to be between 9,000-14,000 new cases per year in the UK. Mortality is about 20-30% and is higher in the elderly.
3. SE is initially treated with benzodiazepines like lorazepam or diazepam. If seizures continue, second line drugs like fosphenytoin or phenytoin are used. For refractory SE, anesthetic drugs under ICU care may be required
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This document provides information on consciousness and coma:
- Consciousness has two components - arousal from the reticular activating system and awareness from the cerebral cortex. Stimulation of the RAS produces arousal while its destruction causes coma.
- The Glasgow Coma Scale and newer scales like FOUR are used to evaluate patients in comatose or reduced states of consciousness. The FOUR scale assesses eye, motor, brainstem, and respiratory responses.
- Causes of coma can be structural/focal brain injuries or non-structural/diffuse issues like hypoxia, infections, or toxic exposures. An approach is outlined to initially stabilize an unconscious patient and guide further examination and investigations.
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1) Coma is defined as a state of unresponsiveness where a patient cannot be aroused even with vigorous stimulation. It involves a lack of arousal and awareness.
2) The ascending reticular activating system and cerebral cortex are the two main anatomical components involved in consciousness. Damage or disturbances in these areas can result in altered mental states ranging from confusion to deep coma.
3) Causes of coma include structural injuries, lack of oxygen/substrates, toxicity from substances, and infections/inflammation of the central nervous system.
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Status epilepticus (SE) is defined as continuous seizure activity lasting more than 5 minutes or 2 or more seizures within 5 minutes without regaining consciousness between seizures. SE can be convulsive, manifesting as tonic-clonic seizures, or non-convulsive, manifesting as confusion or impaired consciousness. Treatment involves initial stabilization, seizure termination through benzodiazepines or other anticonvulsants like phenytoin, and management of refractory SE with anesthetic agents if needed. Prolonged SE can cause neurological damage and is associated with higher mortality and morbidity.
Coma
1. Coma results from damage to the reticular activating system in the brainstem or widespread damage to both cerebral hemispheres.
2. Lesions in the upper brainstem can cause pupillary dilation and loss of eye movement, while more diffuse lesions cause preserved pupillary function.
3. Cerebral mass lesions and herniations, like uncal herniation, can compress brain structures and blood vessels, causing coma.
4. Metabolic disorders that disrupt brain energy supply like hypoglycemia or hypoxia can induce coma by interrupting neuronal function.
Epilepsy
This document defines epilepsy as a chronic neurological disorder characterized by recurrent seizures resulting from abnormal neuronal activity in the brain. Seizures can vary in severity from brief periods of lack of awareness to major motor convulsions. Epilepsy is classified based on whether seizures originate in one area of the brain (focal) or engage both hemispheres (generalized). Common causes include trauma, tumors, infections, genetic factors, and metabolic imbalances. Diagnostic workup may include EEG, CT/MRI, and genetic testing. Treatment primarily involves anti-seizure medications, while refractory cases may be treated with surgery to remove the seizure focus.
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Coma_.pptx
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2) Signs of increased ICP include changes in level of consciousness, vital signs, pupillary changes, and extraocular movements.
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status epilepticus presentation
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
COMA
1) Coma is defined as a state of unresponsiveness where a patient cannot be aroused even with vigorous stimulation. It involves a lack of arousal and awareness.
2) The ascending reticular activating system and cerebral cortex are the two main anatomical components involved in consciousness. Damage or disturbances in these areas can result in altered mental states ranging from confusion to deep coma.
3) Causes of coma include structural injuries, lack of oxygen/substrates, toxicity from substances, and infections/inflammation of the central nervous system.
coma
This document discusses coma and disorders of consciousness. It defines coma as a state of unresponsiveness and unconsciousness, and notes that coma can be a medical emergency requiring intervention. The document outlines different levels of arousal from alert to coma and describes conditions like encephalopathy, locked-in syndrome, and persistent vegetative state. Causes of impaired consciousness discussed include alcohol, epilepsy, intoxication, trauma, infection, stroke, and hypoxia-ischemia. The Glasgow Coma Scale for assessing coma is also summarized.
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1) A 7-year-old girl with a history of recurrent asthma exacerbations presented with severe respiratory distress.
2) In the emergency department she was conscious but agitated, talking in short sentences, and had increased work of breathing with wheezing. Her oxygen saturation was 92% on 6L oxygen.
3) She was assessed as having moderate status asthmaticus. Treatment would include oxygen to maintain saturation above 92%, systemic corticosteroids started within the first 48 hours, and inhaled short-acting beta-agonists.
Seizure
This document discusses seizure disorders and epilepsy. It defines seizures and classifies them as partial or generalized. Some common causes of seizures are then listed. Nursing management of seizures is mentioned. Epilepsy is defined as recurring unprovoked seizures. Some common causes and clinical manifestations of epilepsy are described. The assessment, diagnostic tests, and considerations for special populations like women and older adults are summarized. Treatment options including pharmacologic therapies and surgical management are covered. Status epilepticus is defined as a medical emergency characterized by prolonged seizures without recovery in between.
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This document discusses neurointensive care, which aims to treat and prevent brain injury. It describes the role of the neurointensivist in comprehensively managing neurologic status while integrating knowledge of other organ systems. Various conditions treated in neurointensive care units are listed, along with assessments of neurologic function and scales used to evaluate levels of consciousness, motor response, and brainstem reflexes. Monitoring techniques and their indications are also outlined.
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METABOLIC ENCEPHALOPATHY BY alveera riyaz
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Dyspnea is a subjective experience of breathing discomfort that results from interactions between physiological, psychological, social, and environmental factors. The document discusses the mechanisms, causes, evaluation, and management of dyspnea. Evaluation involves obtaining a thorough history regarding onset, timing, severity, and relieving/precipitating factors. A physical exam focuses on vital signs, respiratory exam, cardiovascular exam, and neurological exam to help identify potential causes like heart failure, COPD, pneumonia, or asthma.
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The document provides an overview of the approach to evaluating and managing patients presenting with coma. It discusses the components of consciousness, relevant anatomy, disorders of consciousness, and a general clinical approach involving taking a history, performing a general and neurological examination to assess level of arousal, brainstem reflexes, and Glasgow Coma Scale. The examination aims to determine the cause of coma and guide immediate management of airway, breathing, and circulation issues.
Status epilepticus
Status epilepticus (SE) is defined as continuous seizure activity lasting more than 5 minutes or 2 or more seizures within 5 minutes without regaining consciousness between seizures. SE can be convulsive, manifesting as tonic-clonic seizures, or non-convulsive, manifesting as confusion or impaired consciousness. Treatment involves initial stabilization, seizure termination through benzodiazepines or other anticonvulsants like phenytoin, and management of refractory SE with anesthetic agents if needed. Prolonged SE can cause neurological damage and is associated with higher mortality and morbidity.
Coma
1. Coma results from damage to the reticular activating system in the brainstem or widespread damage to both cerebral hemispheres.
2. Lesions in the upper brainstem can cause pupillary dilation and loss of eye movement, while more diffuse lesions cause preserved pupillary function.
3. Cerebral mass lesions and herniations, like uncal herniation, can compress brain structures and blood vessels, causing coma.
4. Metabolic disorders that disrupt brain energy supply like hypoglycemia or hypoxia can induce coma by interrupting neuronal function.
Epilepsy
This document defines epilepsy as a chronic neurological disorder characterized by recurrent seizures resulting from abnormal neuronal activity in the brain. Seizures can vary in severity from brief periods of lack of awareness to major motor convulsions. Epilepsy is classified based on whether seizures originate in one area of the brain (focal) or engage both hemispheres (generalized). Common causes include trauma, tumors, infections, genetic factors, and metabolic imbalances. Diagnostic workup may include EEG, CT/MRI, and genetic testing. Treatment primarily involves anti-seizure medications, while refractory cases may be treated with surgery to remove the seizure focus.
Super refractory status epilepticus. How long should we persevere? - Hirsch
Super refractory status epilepticus is a rare but serious condition seen in neurointensive care units where seizures continue despite treatment with general anesthesia. The aetiology and prognosis varies, with conditions like autoimmune encephalitis from anti-N-methyl-D-aspartate receptor antibodies having a better outlook if treated early with immunotherapy and tumor removal. Intensive care management aims to control seizures, support ventilation, and treat the underlying cause like removing ovarian teratomas in anti-NMDAR encephalitis patients. While morbidity and mortality is high, complete recovery is possible even after months of status epilepticus depending on the specific cause.
Altered Level of Consciousness
The document discusses altered levels of consciousness. It defines consciousness and covers a spectrum from consciousness to coma. It describes states of lethargy, stupor/obtunded, and coma. Coma is defined as a state of unconsciousness where a person cannot be aroused. Other altered states like akinetic mutism and persistent vegetative state are also described. Potential causes of altered consciousness including structural issues, functional problems, metabolic derangements, drugs, toxins, and others are outlined. The assessment, investigations, treatment and management of patients with altered consciousness are discussed in detail.
Movement Disorders
This presentation summarizes abnormal movement disorders, focusing on two patient cases. Patient 1 is a 15-year-old female presenting with abnormal movements and was diagnosed with rheumatic chorea. Patient 2 is a 60-year-old diabetic female also presenting with abnormal movements, who was diagnosed with hyperglycemia-induced chorea. The presentation defines chorea and outlines its characteristic features and various causes, including hereditary, metabolic, endocrine, drug-induced, and those associated with other systemic diseases. Rheumatic chorea and chorea with nonketotic hyperglycemia are discussed in more detail.
Status epilepticus
Status epilepticus is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. It can be convulsive, involving motor symptoms, or non-convulsive without obvious symptoms but still involving abnormal brain activity. Causes include prior epilepsy, trauma, infection, drugs or metabolic imbalances. Treatment aims to stop seizures quickly with benzodiazepines or anti-seizure drugs to prevent complications like cardiac or respiratory issues, metabolic disturbances and neuronal damage. Prolonged status epilepticus can lead to a refractory state requiring intensive care management to prevent disability or death.
Seizure and epilepsy
The document provides information on seizures, convulsions, and epilepsy. It defines these terms and describes the different types of seizures including partial/focal seizures and generalized seizures. It discusses the causes, signs and symptoms, diagnostic evaluation, and management of seizures which includes anti-seizure medications, surgery, and vagus nerve stimulation. Nursing care focuses on protecting the individual during a seizure and observing/reporting seizure characteristics. Complications include prolonged seizures known as status epilepticus.
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This document discusses encephalopathy and summarizes key points about its causes, features on EEG, and types. Encephalopathy is defined as altered brain function resulting in impaired consciousness. It can be caused by metabolic, toxic, infectious, hepatic or other issues. On EEG, encephalopathy typically shows generalized slowing and reduced reactivity. Specific patterns like triphasic waves indicate metabolic encephalopathy. The document outlines different types of encephalopathy and their associated EEG findings to help evaluate severity and guide treatment.
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This document provides an overview of neurologic disorders, focusing on head trauma and spinal cord injury. It discusses the pathophysiology, clinical manifestations, classifications, and initial management of traumatic brain injury and spinal cord injury. Some key points include:
- Head trauma is a broad classification that includes injury to the scalp, skull, or brain and is a leading cause of death from trauma.
- Primary brain injury occurs at the time of impact while secondary injury involves damage over subsequent hours and days.
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status epilepticus in child je workshop mks
Status epilepticus is a medical emergency defined as continuous seizure activity lasting more than 30 minutes or recurrent seizures without regaining consciousness between seizures. It requires prompt treatment to prevent neurological injury and death. The document discusses the epidemiology, pathophysiology, treatment, and prognosis of status epilepticus. Initial treatment involves maintaining airway, breathing, and circulation while administering benzodiazepines like lorazepam or diazepam. For refractory cases, additional anticonvulsants like fosphenytoin, phenobarbital, midazolam, or propofol may be used. Outcomes depend on factors like duration and etiology of seizures, with mortality ranging from 3-30
Epilepsy
This document defines epilepsy and seizures, and discusses their incidence, causes, classification, evaluation, and management. Some key points:
- Epilepsy is defined as recurrent seizures unrelated to fever or acute brain injury. Seizures affect 3-5% of children.
- Causes of epilepsy include hypoxia, infection, trauma, developmental defects, and genetic conditions like tuberous sclerosis.
- Seizures are classified as partial/focal or generalized. Common generalized seizures include grand mal and absence seizures.
- Evaluation involves medical history, physical exam, and in some cases tests like EEG. Management focuses on anticonvulsant drugs tailored to seizure type. Surgery may be an option for drug-
Seizures
A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness. If you have two or more seizures or a tendency to have recurrent seizures, you have epilepsy.
epilepsy.pptx
Management of patient with Epilepsy involves treating acute seizures, identifying and removing underlying causes, and long-term antiepileptic drug therapy. Seizures are classified as partial or generalized based on origin in one brain region or both hemispheres. Evaluation includes thorough history, physical exam, EEG and imaging to diagnose epilepsy and guide treatment. Management focuses on controlling seizures through medications while also addressing psychosocial needs through rehabilitation. Surgery may be considered for drug-resistant epilepsy localized to one brain region.
Cnv disorders
1. The document discusses nervous system disorders including intracranial pressure, components of the brain, causes of increased ICP, signs and symptoms, investigations, and management of increased ICP including drug therapy and nursing care.
2. It also covers topics such as stroke, including types, signs and symptoms, diagnosis using FAST test, treatment including thrombolysis and antiplatelet/anticoagulant drugs, and nursing care to monitor patients and prevent complications.
3. Finally, it briefly discusses meningitis as an inflammation of the lining around the brain and spinal cord often caused by bacteria or viruses.
Epilepsy and management
Epilepsy is a chronic neurological condition characterized by recurrent seizures caused by abnormal electrical activity in the brain. It affects about 50 million people worldwide, with 200,000 new cases occurring each year. Epilepsy can be caused by genetic and structural factors like head injuries or infections. Seizures are classified as partial or generalized depending on where they originate in the brain. Treatment involves anticonvulsant drugs to control seizures as well as non-pharmacological options like dietary changes or surgery for severe cases. The goal of treatment is achieving seizure freedom without side effects.
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- 1. ALTERED LEVEL OF CONSCIOUSNESS
- 3. COMA > is a clinical state of unconsciousness in which the patient is unaware of self or the environment for prolonged periods. AKINETIC MUTISM > a state of unresponsiveness to the environment which the patient makes no movement or sounds but sometimes opens the eyes. PERSISTENT VEGETATIVE STATE > is a condition which the patient is described as wakeful but devoid of conscious content, without cognitive or affective mental function.
- 5. LEVEL OF CONSCIOUSNESS : LEVEL I- CONSCIOUS > normal awareness oriented to time, person, and place. LEVEL II- LETHARGY SOMNOLENCE DROWSINESS OR OBSTUNDATION > responds with confusion alone, falls alone to sleep; responds briefly to stimuli. LEVEL III- STUPOR > physical and mental activity is minimal. > Reflexes and sphincter actions are not changed. > Patient awareness by vigorous stimulation. LEVEL IV- SEMI-COMA > no spontaneous movement, withdrawal from painful stimuli and verbal response are limited to groaning. > vomiting. > reflex activities. COMA OR DEEP COMA > no spontaneous movement.
- 17. INCREASED INTRACRANIAL PRESSURE (ICP)
- 24. BLOOD PRESSURE MEDICATION > required to maintain cerebral perfusion at a normal level. > notify the physician if the BP range is below 100 or above 150mm Hg systolic. ANTIPYERETIC AND MUSCLE RELAXANTS > temperature reduction decreases metabolism, cerebral blood flow, and thus ICP. > prevents shivering. ANTICONVULSANTS > may be given prophylactic ally to prevent seizures. > seizures increase metabolic requirements and cerebral blood flow and volume and increase ICP. IV FLUIDS > administration via infusion pump to control the amount of IV fluid treatment. > Hypertonic IV solutions are avoided because of the risk of promoting additional cerebral edema.
- 26. SEIZURES
- 28. MYOCLONIC >a seizure that presence as a brief generalized jerking or stiffening of extremities. > the victim may fall to ground as a result of seizure. ATONIC OR AKINETIC ( DROP ATAACKS ) > a sudden momentary loss of muscle tone. > The victim may fall to ground as a result of the seizure. PARTIAL SEIZURE : SIMPLE PARTIAL > produces sensory symptoms accompanied by motor that are localized or confined to a specific area. > client remains conscious and report an aura > with autonomic symptoms > with special sensory and somatosensory symptoms. COMPLEX PARTIAL > with impairment of consciousness only. > a psycho motor seizure. > characterized by periods of altered behavior that the client is not aware of. >the client loses of consciousness for a few seconds.
- 33. HEADACHE
- 39. CLINICAL MANIFESTATIONS: I.MIGRAINE PRODOME PHASE : depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increase urination, diarrhea, constipation. AURA PHASE : characterize by focal neurologic symptoms, visual disturbances, numbness and tingling of face and lips, hand, mild confusion, slight weakness of extremity, drowsiness, dizziness. HEADACHE PHASE: a vasodilatation and a decline in serotonin level occur, a throbbing headache over several hours. Severe anticipating; associated with photo phobia, nausea and vomiting. RECOVERY PHASE : pain gradually subsides; muscle in the neck and scalp; muscle ache, localized tenderness, exhaustion and mood changes.
- 40. II.TENSION PHASE: ·steady, constant feeling of pressure that usually begins in forehead, temple or back of the neck. III. CLUSTER HEADACHE: ·are unilateral and come in clusters of one to 8 daily with excruciating pain localized to eye and orbit radiating to the facial temporal regions. ·Pain accompanied by watering eye and nasal congestion. IV. CRANIAL ARTERITIS ·fatigue, malaise, weight lose and fever ·inflammation usually are present ·sometimes a tender swollen or nodular temporal artery is visible.
- 43. Anthony Toledo, MD, RN