By U. Quadir. William Jewell College.
The Editors Nabil Kitchener order flexeril 15mg on-line, Saher Hashem discount flexeril 15mg, Mervat Wahba Egypt, USA, January 2012 7 | Editors Authors Nabil Kitchener, MD, PhD Magdy Khalaf, MD Professor of Neurology, GOTHI, Consultant Neurologist and Egypt Chairman of Neurocritical Care President of Egyptian Cerebro- Unit Cardio-Vascular Association GOTHI, Egypt (ECCVA) and Board Director of World Stroke Organization Bassem Zarif, MD (WSO) Lecturer of Cardiology www. Basic Hemodynamic Monitoring of Neurocritical Patients... Assessment of Patients in Neurological Emergency Nabil Kitchener, Saher Hashem Care in specialized intensive care units (ICUs) is generally of higher quality than in general care units. Neurocritical care focuses on the care of critically ill patients with primary or secondary neurosurgical and neurological problems and was initially developed to manage postoperative neurosurgical patients. It expanded thereafter to the management of patients with traumatic brain injury (TBI), intracranial hemorrhage and complications of subarachnoid hemorrhage; including vasospasm, elevated intracranial pressure (ICP) and the cardiopulmonary complications of brain injury. Neurocritical care units have developed to coordinate the management of critically ill neurological patients in a single specialized unit, which includes many clinical domains. Care is provided by a multidisciplinary team trained to recognize and deal with the unique aspects of the neurological disease processes, as several treatable neurological disorders are characterized by imminent risk of severe and irreversible neurological injury or death if treatment is delayed. Some diseases need immediate action, so admission to the NICU is the best solution when there is: 14 | Critical Care in Neurology 1) Impaired level of consciousness. In the Neurocritical Care unit, patients with primary neurological diseases such as myasthenia gravis, Guillain-Barré syndrome, status epilepticus, and stroke have a better outcome than those patients with secondary neurological diseases. So, we can conclude that these specialized units have greater experience in the anticipation, early recognition, and management of potentially fatal complications. Early identification of patients at risk of life threatening neurological illness in order to manage them properly and to prevent further deterioration is the role of general assessment of new patients in a neurological emergency. The neurologic screening examination in the emergency settings focuses primarily on identifying acute, potentially life- threatening processes, and secondarily on identifying disorders that require other opinions, of other specialists. The importance of urgent neurologic assessment comes from recent advances in the management of neurologic disorders needing timely intervention like thrombolysis in acute ischemic Assessment of Patients in Neurological Emergency | 15 stroke, anticonvulsants for nonconvulsive and subtle generalized status epilepticus, and plasmapheresis for Guillain-Barré, etc. It is obvious that interventions can be time-sensitive and can significantly reduce morbidity and mortality. A comprehensive neurologic screening assessment can be accomplished within minutes if performed in an organized and systematic manner (Goldberg 1987). Neurologic screening assessment includes six major components of the neurologic exam, namely: 1) Mental status 2) Cranial nerve exam 3) Motor exam 4) Reflexes 5) Sensory exam 6) Evaluation of coordination and balance. Based on the chief findings of the screening assessment, further evaluation or investigations can be then decided upon. History A careful history is the first step to successful diagnosis, and then intervention. For example, an alert patient with a headache associated with neck pain that started after a car accident might help direct the examination and radiographic imaging to focus on cervical spine injury or neck vessels (carotid or vertebral artery) dissection, while the same patient not in a car accident may direct your attention to a spontaneous subarachnoid hemorrhage. Dramatic or acute onset of neurologic events suggests a vascular insult and mandates immediate attention and intervention. A full mental status exam is not necessary in the patient who is conscious, awake, oriented, and conversant; on the contrary it must be fully investigated in patients with altered mental status. Sometimes, we can find no change in mental status; at that point careful consideration should be given to concerns of family. A systematic approach to the assessment of mental status is helpful in detecting acute as well as any chronic disease, such as delirious state in a demented patient (Lewis 1995).
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