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1、h Frequently occur h Rapidly assess h Accurate diagnosis h Effectively manage h Severe permanent sequelae (后遗症) hPrimary: initial structural damage upon injury JNeurons JSupporting tissues JBlood vessels hStem cell offers hope h Secondary: progressive cellular dysfunction hypoxia, hypotension, seizu
2、res, hyper-thermia, etc. JTreatments lighten secondary injury JAs soon as possible irreversible h Traditional examination doesnt work. History PE DD Diagnostic tests Treatment h Parallel processes at different levels of patient management are required. Treatment PE Diagnostic tests DD History h AIRW
3、AY h BREATHING h CIRCULATION h Neurological status JLevel of consciousness JPupils h Patent (通畅的) h Common causes LVomitus (呕吐物) LTongue obstruction h Procedures JCheck and clear mouth (suction,抽吸) JPositioning Jintubation (插管) h Procedures JCheck and clear mouth h Procedures JPositioning (head-tilt
4、, chin-lift) h Procedures JIntubation h Monitor oxygen saturation h Supplemental oxygenation h ECG h Heart rate & cardiac rhythm h Blood pressure h Complete blood count h Blood glucose h Electrolyte h BUN & Cr h The most sensitive indicator h Definitions: LDrowsiness (嗜睡) LStupor (昏睡) LComa LConfusi
5、on (意识模糊) 丘脑丘脑 网网 状状 激激 活活 系系 统统 h AVPU h GCS h Pitfalls hAlert hVerbal Stimulus Response hPainful Stimulus Response hUnresponsive hEye opening hBest verbal response hBest motor response EYE OPENING Spontaneous 4 To voice3 To pain2 None 1 BEST VERBAL RESPONSE Orientated (定 向) 5 Confused 4 Inappropri
6、ate 3 Incomprehensibl e 2 None 1 BEST MOTOR RESPONSE Obeying6 localizing5 Withdrawing 4 Flexing (decorticate) 3 Extending (decerebrate) 2 None 1 h Decorticate (去皮层) posturing h Decerebrate (去大脑) posturing h Interpretation Minor13-15 Moderate 9-12 Severe 3-8 h Persistent vegetative state h Locked-in
7、syndrome h Psychomotor inhibition (e.g. flexibilitas cerea 蜡样屈曲) h Coma h Increased intracranial pressure h Myasthenic crisis h Stroke/TIA h Seizure & status epilepticus With Focal signs OR Meningeal irritation Without Focal signs Meningeal irritation Common Causes Metabolic disturbances Stroke Tumo
8、r Abscess / SAH Meningitis Encephalitis StructuralStructural disordersdisorders CT scan /MRI CSF Common Causes Metabolic disturbances Stroke Tumor Abscess / SAH Meningitis Encephalitis StructuralStructural disordersdisorders hBlood glucose hComplete blood count & coagulation screen hElectrolyte hBUN
9、 & Cr hLiver function tests (esp. blood ammonia氨 level) hArterial blood gas analysis hChest X-ray hToxicology screen hBlood, urine culture h Parallel processes JABCs and the LOC JAn intravenous line JBlood sample JPupils mannitol (甘露醇) h Find the cause & treat it accordingly h Supportive measures JN
10、utritional support Caloric requirements Fluid volume Electrolytes JComplications Aspiration (误吸) Impaired skin Contractures (挛缩) of joints h Cushing triad (三联征) JHeadache JVomiting JPapilloedema (视乳头水肿) NormalNormal h Cushings reflex JHypertension JBradycardia h Other signs JLevel of consciousness J
11、Respiratory changes JDiplopia (VI) 扣带回疝，大脑镰下疝扣带回疝，大脑镰下疝 穿颅疝穿颅疝 颞叶钩回疝颞叶钩回疝 小脑扁桃体疝小脑扁桃体疝 幕上幕上 幕下幕下 小脑幕切小脑幕切 迹疝迹疝 h Closely monitor JLevel of consciousness JPupils (size, equality, reaction to light) JVital signs JICP h Closely monitor JICP h Closely monitor JICP h Osmotic Diuretics (渗透性利尿剂) JMannitol (甘露醇) is the most effective JFurosemide (速尿) JGlycerol (甘油) h Hypothermia h CSF drainage h Decompressive craniotomy (去骨瓣减压术) 单击此处编辑 母版标题样式 单击此处编辑母版副标题 样式