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Neurological Emergencies

Meningitis

  1. Outside hospital: IV/IM benzylpenicillin
  2. ABC, high flow Oxygen, IV+fluid resuscitation
  3. Cefotaxime. Dexamethasone.

Status epilepticus

  1. Contact an aesthetist
  2. ABC: open and maintain the airway, lay in recovery position, remove false teeth if poorly fitting, insert oral/nasal airway, intubate if necessary
  3. 100% oxygen + suction as required
  4. IV access, take blood:
    U+E, LFT, FBC, glucose (exclude hypoglycaemia)
    Toxicology screen if indicated, anticonvulsant levels
  5. Thiamine IV if alcoholism. Unless glucose known to be normal deliver.
  6. Correct hypotension with fluids
  7. Slow IV fluid bolus of lorazepam
  8. If seizures continue: phenytoin
  9. Last resort is general anaesthesia

Stroke

  1. Airway: Put in recovery position. Refer to Speach and Language team to check swallowing.
    Breathing: Deliver oxygen.
    Circulation: IV access, and ensure hydration.
  2. Measure and treat hypoglycaemia
  3. Investigations: Urine sample
    ECG (atrial fibrillation?)
    Bloods: FBC, U+E, glucose, lipids, platelets, clotting (brain haemorrhage?), ESR
    CXR. Carotid doppler. Consider echo heart.
    CT: urgent if less than 3h or posterior circulation lesino, otherwise 3-5d
  4. Treatment: Aspirin 300mg, consider thrombolysis.
    Treat pressure sores, give NG tube and catheterise if necessary. DVT prophylaxis.
  5. Secondary stroke prevention measure
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