??a???e??efa????? ?a??se?? (???)

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??a???e??efa????? ?a??se?? (???)

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????s? ??, ?ad??a?d?a (Cushing's reflex) ?p?s?????d?? ?? ?t? a ... ????da Cushing's. a??? ??? e?d???????? p?es?. ???? ??? ??. ??ad??a?d?a. ?a???????? a?ap??? ... – PowerPoint PPT presentation

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Title: ??a???e??efa????? ?a??se?? (???)

1
??a???e??efa????? ?a??se?? (???)

??d???a ?s?????
??e?µ????????-??tat????????
?p?µe??t??a ? ?????T ????

2
?p?pt?s? ???

4 e?at?µµ???a t? ?t?? st?? ???
450.000 ??e?????ta? ??s??e?a
75.000 ???at??
?? ????? a?t?? ?a??t?? st?? ?????e? 15-40 et??
????? a?t?? a?ap???a?
St?? p?e????f?a t??? ?p?e? ?a??se??
?? ßa???? ?a??se?? e??a? t? ????? a?t?? ?a??t??
sta ???t?a t?a?µat?? (gt50)

3
?µ?de? ?????? ???d????

? ?????te?? ??d?e? 15-24 et??
????? pa?d?? 6 µ???? ??? 2 et??
?a?d?? µ????? s??????? ?????a?
??????µ????

4
??at?µ?a ??a????

??p?? st??µa ste?e?? ?st??, p?? pe??ß???e? t? ?s?
sp????de? ?st?
?et?p?a??, ß?e?µat???, ???taf???, ???a??,
µast?e?d??
??t? ap? t? ???taf??? ?st?
??s? µ???????? a?t???a
S????e? a?t?? ep?s?????d??? a?µat?µat??

5
??at?µ?a e??ef????

?ata?aµß??e? t? 80 t?? e?d???????? ?????
??a????eta? se
e??efa???? ?µ?sfa???a
pa?e??efa??da
st??e???

6
??at?µ?a e??ef????

?µ?sfa???a
f?????
????s?e? ????se??
?p?ped? s??e?d?s??
?et?p?a??? ??ß??
p??s?p???t?ta
??e?µat???? ??ß??
a?s??t???t?ta
µ??µ?
s??a?s??µata

7
??at?µ?a e??ef????

???taf???? ??ß??
???t?? ?????
?a????????a µ??µ?
?e?s?
?sf??s?
???a??? ??ß??
??as?
?p????aµ??
???t?a eµ?t??, ???µ?s?? ?e?µ???as?a? ?a?
?µ???stas?? ?dat??
??e???? ?p???-af?p??s??
??e??
???aµ??
S??a?s??µata, af?p??s?
pa?e??efa??da
S???????sµ?? e???s??? µ????? ????se??
T?s?, ?s????p?a

8
??at?µ?a e??ef????

St??e???
S??d?e? ta ?µ?sfa???a, t?? pa?e??efa??da ?a? t?
??t?a?? µ?e??
?pe????? ??a f?t???? ?e?t?????e?
1. ?ese???fa???
???????ta? ?pt??? ?a? a???st??? e?e??sµata
2. G?f??a
S??det??? deµ?t?a µeta?? e??ef???? ?a? ?????
s?µe??? t?? s?µat??
3. ???µ???? µ?e???
???t?a ?a?d???, a?ap????, a??e??????t???
??e???? ?µet?? ?a? ß??a

9
??at?µ?a e??ef????

??a??a?? ?e??a
???t??t?? s??µat?sµ??
ep?ped? s??e?d?s?? (?????? ??e???? µa?? µe t?
f????)
??????e?
1. s????? ? e??te????, d?a?????e? t??
pa?e??efa??da ap? t?? ???e? e??efa????? d?µ??
2. a?a???e?d?? pe????e? ta a??e?a p??
epa?a???f??? t? ???
3. ?????e?d?? ste?e? p??sdes? µe t?? e??efa????
?st?

10
???efa????t?a?? ???? (???)

??a????, ?a?a??
?????f??e? d?a t?? e??ef???? ?a? t?? ??t?a???
µ?e???
?e??ß???e? ?a? p??state?e?
?????e?
St? ???t?? t?? e??ef????
?a?????? ???

11
?etaß???sµ?? ?a? ??µ?t?s? t?? ???ef????

?????? µetaß?????? ???µ??
?ata?a???e? t? 20 t?? ?????? ????????
?e???? ?ata????s? ????????
?e? ap????e?e? ??ept???? ??s?e?
??µ?t?s?
e??efa????? a?t???e?
?? ?a??t?d???? a?de???? t? µe?a??te?? µ????
t?? ?µ?sfa?????
?? sp??d?????? a?de???? t?? pa?e??efa??da ?a?
t? st??e???

12
?etaß???sµ?? ?a? ??µ?t?s? t?? ???ef????

a?µ?t?s?
???efa???? a?µat??? ??? (CBF)
?a?????eta? ap? t? CPP
???efa???? p?es? ??de?s??-Cerebral Perfusion
Pressure (CPP)
? ?d???? p?es? a?µ?t?s?? t?? e??ef????
? a?t?????µ?s? ep?t??pe? t? d?at???s? sta?e???
CPP pa?? t?? µetaß???? t?? ??
CPP Mean Arterial Pressure (MAP) - Intracranial
Pressure (ICP)
??d???????? ??es?- Intracranial Pressure (ICP)
ICP usually 10-15 mm Hg
????s? se ??d?µa, a?µ???a??a
?pa?te?ta? ??? t??????st?? 60 mm Hg ??a d?at???s?
epa????? CPP

13
???a??sµ?? ????s??

1. t???a?a
?? s?????ste?? a?t?? ???
?? s?????ste?? a?t?? ?p?s?????d??? a?µat?µat??
2. pt?se??
??????µ????, a?????
S?et????ta? µe ?p??????d?a a?µat?µata
3. ??at?t?a???? t?a?µa

14
?at?????e? ß??ß??

Coup injury
St? s?µe?? t?? p????? S?????ste?e? se p??s??a
p????
Contrecoup injury
??t??eta t?? ß??ß??
S?????? se ?p?s??e? p???e??
?????t? ??????? ???ß? - Diffuse Axonal Injury
(DAI)
???tµ?s? t?? ?e?????? ???? S?????ste?e? se ??µata
e?t?? a?t?????t?? ?a? se pe????
?st?a?? ???ß?
??t?p?sµ???

15
???efa???? ????s?

??e?? µe???e? ?at?????e?
?st?a?? ß??ß?
???efa???? ???s?
??d???a??a??? a?µ???a??e?
?p? ?p?- s?????d?e? a?µ???a??e?
?pa?a???e?d?? a?µ???a??a
?????t? a?????? ß??ß?
???se?s? (? ?p??te?? ?a? ??as??? µ??f? )

16
??t?a e??efa????? ß??ß??

?µesa a?t?a
???ß? ??tt????
???e?a?? d?ape?at?t?ta, ????
?µµesa (de?te??pa??) a?t?a
??d?µa, a?µ???a??a, ???µ???, a?epa???? a?µ?t?s?,
?st??? ?p???a

17
?a??f?s??????a e??efa????? ß??ß??

?ta? ICP ? ?a? p??se????e? t? MAP, ? e??efa????
??? a?µat?? ?
?? a?t????p?st???? µ??a??sµ?? p?? p??spa???? ?a
d?at???s??? t? ??? af????? a??e??d?ast??? t??
e??efa????? a??e???, p?? s??ep??eta? pe?a?t??? ?
ICP ?a? ??a ? CPP

18
?a??f?s??????a e??efa????? ß??ß??

? ?pe??ap??a p???a?e? e??efa???? a??e??d?ast???
? ????? a?µat?? ? ? ICP ? CPP
? ?p?tas? ? CPP ? e??efa???? a??e??d?ast???
? ????? a?µat?? ? ? ICP ? CPP

19
??????? e????a a?a????? ep?p?d?? a???s?? ICP

F?????, a??te?? st??e???
???d?? ??
???e? a?t?d??se?
??ap??? Cheyne-Stokes
?????? e?t?p?s? st?? p???
??s? st??e???
????? sf??µ??, ß?ad??a?d?a
???e? µ? a?t?d??se?
?e?t????? ?pe?ae??sµ??
??tas?

20
??????? e????a a?a????? ep?p?d?? a???s?? ICP

?at?te?? st??e???
??d??as? st? µ???? t?? ß??ß??
?ta?t? a?ap??? ? ?p???a
?a?a?? pa????s?
???µa??? ? µetaßa???µe??? sf??µ??
?e??µ??? ??
S?????? de? ep?ß??????
e????easµ??
??as????d?a???
???a???

21
?a??se?? ?at? e?t?p?s?

?a??se?? t????t?? ?efa???
s????e??
µe???? a?µ???a??a ???? t??
a??e??ß???e?a?
µp??e? ?a p??????e? ?p????a?µ?a sta pa?d??

22
?at??µata ??a????
??aµµ???
eµp?est???
aste??e?d?
Bas???
23
?at??µata ??a????

G?aµµ??? ??ta?µa
?? 80 t?? ?ata?µ?t??
?e? a?a????????ta? ?µesa
?p???a ap? t? µ??a??sµ? t?? ß??ß?? ?a? t??
t?a?µat?sµ? ?pe??e?µe??? µa?a??? µ?????
??? epe????ta
???taf??? pe????? ep?s?????d?a a?µat?µata

24
?at??µata ??a????

?µp?est???
??es? e??ef???? ?a? e??efa???? ß??ß?
?as???
??s???? ?a ape?????st??? se ?/a
?a?a?t???st??? e???µata
?t?????a
????????a
pe???f?a?µ??? e???µ?s?
Battles sign

25
?as??? ?at??µata

??? ?a?a?????µe ta a?t??
??? a?a???f??µe
??? d?e??e????µe t? µ?t?

26
?????t? ??ta?µa ??a????

???es? pe??e??µ???? ??a????
Saf?? ??????? e????a
?µes? a?t?µet?p?s?

27
??d??????a a?µat?µata

?p?s?????d??
?p?s?????d??
??d?e??efa????

28
?p?s?????d?? a?µ?t?µa

??µa µeta?? ??a???? ?a? s?????? µ?????a?
S?????? ap? ???? t?? µ?s?? µ????????? a?t???a?
????a???? a???s? t?? e?d??????a? p?es??

29
?p?s?????d?? a?µ?t?µa

?p??e?a s??e?d?s??, f?te??? d???e?µµa
?a?e?a ep?de???s?
?efa?a???a, ?a?t?a, ?µet??
?µ?p??es?, ?µ?p????a
???s?????a
????s? ??, ß?ad??a?d?a (Cushings reflex)

30
?p?s?????d?? ??µ?t?µa

?eta?? s?????? µ?????a? ?a? a?a???e?d???
?a s?????ste?a
S?????? f?eß??? (f??ße? µeta?? f????? ?a?
s??????)
????a???? a???s?? t?? e?d??????a? p?es??

31
?p?s?????d?? ??µ?t?µa

??? a??? e??????
?efa?a???a, ?a?t?a, ?µet??
?µ?p??es?, ?µ?p????a
???s?????a
????s? ??, ß?ad??a?d?a (Cushings reflex)

32
??d?e??efa???? a?µ?t?µa

???efa???? ????
??µ???a??a e?t?? t?? e??efa????? ??s?a?
S?et????ta? ?a? µe ???e? ß??ße? (DAI)
?? ß??ße? e?a?t??ta? ap? t? µ??e??? ?a? t??
e?t?p?s?
???????? t?? e?d??????? p?es?

33
???ß? e??efa????? pa?e???µat??

????
???se?s?
T??s?

34
???se?s?

?a??d??? ap??e?a s??e?d?s??
???d??µ? aµ??s?a, s????s?
??t?µat? ?p?????s?, ????? e??e?µµata
S?????? se aµß?? t?a?µa
S??d??µ? µeta-d??se?s?
?efa?a???a, ?at??????, d?ata?a???
p??s?p???t?ta?

35
??t?µ?s? ???

? ????fa??? pe????e?eta? se a???d?t? d?aµ???sµa

?as???? s?µas?a? ? d?????s? ?a? ? ??e???? t??
e?d??????a? ?p??tas??
CPP MAP - ICP

37
??t?µ?s? ???

?? µe??µ??? ep?ped? s??e?d?s? ? ?a??te??? de??t??
?? as?e?e?? p?? de? e?te???? e?t???? ????? 25
p??a??t?ta ?a ??e?as???? ?e????????? pa??µßas?

38
??t?µ?s? ???

AVPU Scale
A Alert
V Responds to Verbal stimuli
P Responds to Painful stimuli
U Unresponsive

39
??t?µ?s? ???

Glasgow Scale
Eye Opening-?????µa ?f?a?µ??
Motor Response-????t??? a?t?d?as?
Verbal Response-?e?t??? a?t?d?as?

40
???µa?a G?as??ß??

?????µa ?f?a?µ??
4 a?t?µat?
3 sta pa?a????µata
2 st?? p???
1 ap??

41
???µa?a G?as??ß??

?e?t??? ??t?d?as?
5 p??sa?at???sµ??? ?µ???a
4 s????t???
3 a?at???pte? ???e??
2 a?at???pt?? ????
1 ?aµ?a ap??t?s?

42
???µa?a G?as??ß??

????t??? ??t?d?as?
6 ?pa??? se pa?a????µata
5 e?t?p?s? st?? p???
4 ap?s??s? st?? p???
3 ap?f????s? (??µ??)
2 ape??efa??sµ?? (??tas?)
1 ?aµ?a a?t?d?as?

43
??t?µ?s? ???

??t?a
?? pa?????? t?? e??ef????
???e??? ?????, s?µµet??a, ap??t?s? st? f??

44
??t?µ?s? ???-a?ap???

1. Cheyne Stokes
?????t? ß??ß? ?µ?sfa?????
2. ?e?t????? ?pe?ae??sµ??
?ese???fa???
3. ?p???a
G?f??a
4. Biot
??? p??µ????
5. ?ta????
?at?te??? p??µ????

45
??t?µ?s? ???

????t??? a?t?d?as?
? as?e??? ???e? ??a ta ???a?
??? ta ???e??
ap?f????s?
ape??efa??sµ??
?µ?p??es? ? ?µ?p????a
?a?ap????a ? tet?ap????a

46
??t?µ?s? ???

??t??? s?µe?a
????da Cushings
a???µ??? e?d???????? p?es?
????µ??? ??
??ad??a?d?a
?a???????? a?ap???

47
??t?µet?p?s? ???

ae?a?????
???stas?a ??SS (Jaw Thrust)
??a???f?s? e????se??
??as?????s? (ap?f??? ???????)

48
??t?µet?p?s? ???

???????s?
100 O2
ae??sµ??
???F?G? ?pe?ae??sµ??
?pe?ae??sµ?? µ??? a?
GCS lt8
ta?e?a ?e????????? ep?de???s?
e?de??e?? e????easµ??

?Pco2,a??e??s?spas?, µe??s? ICP
???d???? µe??s?? e??efa????? a?µ?t?s??
49
??t?µet?p?s? ??? ?????f???a

??at???s? epa????? ??
St???? ??? 90 mm Hg ? CPP gt60 mm Hg

50
??t?µet?p?s? ???-Ge???? ??t?a

?????t?p???s? SS
Se f?s???????? ?? t? p??s??fa?? t?? ??eßat???
st?? 300
?p?f??? ?pe??e?µ?a?

51
??t?µet?p?s? ???-Fa?µa?e?t??? ??t?a

Ma???t???
Osµ?t??? d?????s?
?e??s? e??efa????? ??d?µat??
???d???? ?p?ß??a?µ?a?
???d???? ep?de???s?? e?d??????a? a?µ???a??a?
F????seµ?d?

52
?pe????ta ?e????????? p??ß??µata

??µa
???e?a?? ???efa???? ?pe?s?d?a
?pa?a???e?d?? ??µ???a??a
?p?????a
S??d??µ? Guillain-Barre

53
K?µa

?e??µ??? ep?ped? s??e?d?s?? as?e????, p?? de?
d??ata? ?a af?p??s?e?
??µ???? ß??ße?
???????- µetaß?????? ß??ße?
????at???? a?t?a

ABCs
???? t? d?e?e???s?!

55
ABC

Airway-ae?a?????
?????e, ?a????se, d?at???se
Se t?a?µa p??stas?a ??SS
Breathing-??ap???
????????e?ape?a
?e??sµ??
Circulation-?????f???a
sf??e??? a?µ?t?s??

56
??????? ??e???? ??µat??

DERM
D Depth of Coma - ß???? ??µat??
E Eyes - µ?t?a
R Respiratory Pattern - a?ap???
M Motor Function ????t??? ?e?t?????a

57
??t?a

???e?
???e???
S??µa
S?µµet??a
?p??t?s? st? f??

58
??ap???

?????
?s?????sta ßa???? ? ep?p??a?e??
p??t?p?
?a?????? ? ?????µ??

59
????s?

p??es??
p???
?????? t?????
S?spas? ? ?a?a?? ?
????s??
S?µµet???? ????s??

60
?e?te???e??? ??t?µ?s?

??t??? s?µe?a
Shock?
?p???a, ?pe??ap??a?
????µ??? ICP ?
??a???st???
?????µ?a?
G??????
???esµ?? ????????
??a??t??? e??tas? (Head-to-Toe)

61
??µ??? ??µa

?s?µµet?a e??e?µµata
?s?µµet?e? ???e?
?p??et??
?st????? t?a?µat??
?a?e?a e?sß???

62
?etaß????? ??µa

S?µµet???? e??e?µµata
?s?µe???e?? ???e?
? p??et??
?st????? µetaß?????? d?ata?a??? ? as???e?a?
???a??te?? ? ?p??e?a ??a???

63
??t?a ??µat??

Alcohol
Epilepsy
Insulin
Overdose
Uremia (Metabolic causes)
Trauma
Infection
Psychogenic
Stroke/Syncope

64
???e?a?? ???efa???? ?pe?s?d?a (???)

???e ??s?????? d?e??as?a p?? d?a??pte? t? ???
a?µat?? se µ?a pe????? t?? e??ef????.

65
?p?pt?s? ???

500.000/ ?t?? se ???
25 pe?a?????
?s?? ep?ß?????? s???? µe ?????????, ??????µ???
p??ß??µata

66
?a??f?s??????a ???

T??µß?s?
?µß???
??µ???a??a
?s?a?µ?a (µe??s? ??)

67
?a?????te? ???d????(t??p?p???s?µ??)

?p??tas?
??p??sµa
Sa??a??d?? d?aß?t??
?a?d??p??e?a
?pe???p?da?µ?a
???p??? µa?µa????
?pe?p??t???t?ta
???s? ???a????

68
?a?????te? ???d????(µ? t??p?p???s?µ??)

F???
?????a
F???
????????? ???
???????µ???t?ta

69
?at?????e? ???

?s?a?µ??? -80 µe 85
??µ???a???? -15 µe 20

70
?s?a?µ??? ???

?p?f?a?? a??e???
T??µß?s?
?µß???
p???e? ap? ?a??t?de?
?????a ???p??? µa?µa????
IV ??s?e?
S?st?µat??? ?p???de?s?
?a?d?a?? a?ep???e?a
?p????a?µ?a

71
(No Transcript)
72
?a??d??? ?s?a?µ??? ???

?a ?e????????? e??e?µµata ?p??????? e?t?? 24 ????
(s?????? se 30 ?ept?) s?????? se ap?f?a??
?a??t?d??
5 ???d???? ??? a?? ?t??

73
??????? e????a ?s?a?µ???? ???

?µf?a?t? ep???at??? ?µ?sfa?????
?te??p?e??? ad??aµ?a, ?pa?s??s?a
?te??p?e??? ?µ?a????a
??sa????a
?fas?a
?? ep???at??
?te??p?e??? ad??aµ?a, ?pa?s??s?a
?p?a??a ?atas?e?ast???
??sa????a

74
Sp??d???ßas??? s??d??µ?

?f??? st??e???, pa?e??efa??da, ?pt??? f????
???????
??p??p?a
??sfa??a
?ta??a, ?µf? µ???? ad??aµ?a

75
??µ???a???? ???

30 µe 50 ???t?t?ta st?? 30 ?µ??e?
?e?te??? as?e?e??
2 t?p??
e?d?e??efa?????, s?????? ap? ??
?pa?a???e?d??, ap? ???? a?e???sµat??

76
??d?e??efa???? a?µ???a??a

?efa?a???a, ?a?t?a, ?µet??
S?????? µe??µ??? ep?ped? s??e?d?s?? µe ?p??tas?
?te??p?e??? ?µ?p????a, ?µ?a?a?s??s?a
???a?? afas?a

77
??af????? d?????s? ???

?a ?s?a?µ??? ????? s?????? p?? a??? e??????
?a eµß????? ????? ta?e?a e?sß??? ?a? t? a?t??
s?????? ???eta? ??????a a?t???pt?
?a a?µ???a???? µe ta?e?a e?sß??? ????? s??????
?a?? ??ßas? (??µa, e????easµ??)

78
F?s??? e??tas? ???

??a???t??? ?at?stas? ?a? s?µpe??f???
????t???t?ta ?a? a?s??t???t?ta ?????
???e? ?a? ??as?
??de??e?? e????easµ??
?p?peda ????????, ??e?t????t??

79
??t?µet?p?s? ???

?e?t??s? e??efa????? a?µ?t?s?? ?a? ???????s??
ae?a?????
d?as?????s? ??a p??stas?a ae?a?????
a?ap???
????????e?ape?a
?pa???? ??

80
??t?µet?p?s? ???

?????f???a
e?asf???s? f?eß???? p??sßas??
??? d?a??µata µe ???????
?a?a???????s? ??G

81
??t?µet?p?s? ???

? a???µ??? ?? a?t?µet?p??eta? µ??? a? e??a?
d???t??? ?s?a?µ???? ???
?? S?? gt220 ? ??? gt120 stad?a?? µe??s?
?aßeta????
??t??p??ss???
?p?st??f? sta p?? ??? ep?peda ?a? ??? se
f?s????????? t?µ??

82
T??µß???s?

Thrombolytic agents
Se as?e?e?? µe ?s?a?µ??? ??? e?t?? 3 ???? ap? t??
??a???

83
?pa?a???e?d?? ??µ???a??a (SAH)

75-80 ???? a?e???sµat??
4-5 ???? a?t????f?eß???? d?sp?as???
10-15 ????st? a?t??
Sp???a se ??????, a??e??t?de?, d?ata?a??? p????,
???s? ???a????, d?epa????tta???? a?a?µ?a
?? 5 t?? p????sµ?? ?p??????eta? ?t? ??e?
a?e???sµa, t? 25-50 a?t?? ?a ??e? s?µpt?µata ?a?
? et?s??? ???d???? ??a ???? e??a? 3.
20.000-30.000 ??e? pe??pt?se?? ???e ????? se ???.
?????e? 55-60 et??, µe t? 20 ?a eµfa???eta? se
?t?µa 15-45 et??.

84
??ßas?- ? ?a???a? t?? 3

1/3 pe?a????? ?µesa
1/3 ep?ß???e? a??? de? a?a??pte? p?????
1/3 ep?ß???e? ?a? ??e? ?a?? ??ßas?

85
??????? e????a SAH

??t??? ?efa?a???a a?f??d?a? ??a????
?µet??, f?t?f?ß?a
???????sµ??
???sß??? ??? ? V s?????a?
St? 30-60 t?? as?e??? p??e?d?p???t???
?efa?a???a, ap? µ???????e??
?? 25 ?s?? e?s????ta? ??a SAH a??fe?e ??t???
?efa?a???a, p?? de? a??????????e

86
??????s?

Computed Tomography95 e?a?s??s?a, gt90
e?d???t?ta
T??µß?? a?µat?? st?? ßas???? de?aµe???
?? p??t?p? t?? a?µ???a??a? ß???? st?? e?t?p?s?
t?? a?e???sµat??

87
(No Transcript)
88
?sf????t?a?a pa?a???t?s?

Se ????? ?p???a µe a???t??? ? aµf?ß??? CT
?????? ???d???? p?????s?? epa?a?µ???a??a? ap?
µetaß??? t?? e?d??????a? p?es??

89
???e????af?a

? a??e????af?a 4 a??e??? e??a? ? e??tas? e??????
?µ?s?? µet? t? sta?e??p???s?
?p??a??pte? t? 80-85 t?? a?t???

90
St?d?a ?at? Hunt ?a? Hess
St?d?? ? ????? s?µpt?µata ? ?p?a ?efa?a???a ?a?
a??e???? d?s?aµ??a St?d?? ?? µ?t??a p??? s?ßa??
?efa?a???a, a??e???? d?s?aµ??a, d?s?e?t?????a
s??????? St?d?? ??? ap??e?a, s????s?, ?p?a
est?a?? e??e?µµata St?d?? IV ???a????, µ?t??a
p??? s?ßa?? ?µ?p??es? St?d?? V ßa?? ??µa,
ape??efa??sµ??
91
??t?µet?p?s? SAH

H-H grade at admission influences subsequent
management
St?d?a 1-2 s?????? de? ??e?????ta? p???µ?
pa????te?s? ENY
?s?e?e?? stad??? gt ??e?????ta? epe????sa
??????st?µ?a
Se as?e?e?? stad??? 4 ?a? 5 ????? p??te?????
epe????sa ?e????????? a?t?µet?p?s? ?a? ?????
s?st????? ?p?st????t??? ?e?ape?a

92
?p?p????? SAH
??e???? ?? ?aßeta????, ?d?a?a????

?pa?a?µ???a??a
???d???? 4 t?? p??te? 24 ??e? ?a? µet? 1.5 t??
p??te? 13 ?µ??e?
?d????fa???
???e??spasµ??
?p??at??a?µ?a ?a? ?p?????a?µ?a
Spasµ??

pa????te?s?
??µ?d?p???
93
?p?????a

?etaß??? st? s?µpe??f???/ ep????????a ????
??a???? ??e?t????? d?ast????t?ta? t?? e??ef????.
S?????? e?d????eta? µe ß?a?e?a epe?s?d?a
µetaß???? ????t???t?ta?
µetaß???? a?s??t???t?ta?
pe??e???? s?µpe??f????
d?ata?a??? ep????????a?

94
??????s? ep???pt???? ???se??

1. Ge???e?µ??e?
t?????-???????? (grand mal)
afa??es? (petit mal)
2. ?st?a???
ap???
s???ete?
3. ?ste?????

95
(No Transcript)
96
??t?a ep???pt???? spasµ??

???
???
?p?????a?µ?a
?e?p??sµata e??ef????
e??aµ??a
?p???a
???µ???/p??et??
St???s? a?????/?a???t????
????t????se??
???e?t?????s?

?? pe??ss?te?e? e??a? ?d??pa?e??
97
?at?????e? ep???pt???? ???se??

Petit Mal
??? spasµ??
??? ap??e?a s??e?d?s??
?a?d??
Grand mal
S?sp?se??
S????
?????e?ta? a??a
??f??d?a ap??e?a s??e?s?s??
?etep???pt??? f?s?

98
Ge???e?µ???? spasµ??

S?µµet?????
S?ed?? ta?t?????? e?e???p???s? ???? t?? f?????

99
?st?a??? spasµ??

?p??? (Jacksonian)
e?t?p?sµ??? ??????? d?ast????t?ta
d?sa?s??s?a
??? d?ata?a??? ep????????a?
µp??e? a?t???µ? d?ast????t?ta ? a?s??t???
S???et?? (????????t???? ? ???taf???? ??ß??)
µetaß???? s?µpe??f????, a?t?µat?sµ??
a??a
epa?a?aµßa??µe?? µ???? d?ast????t?ta

100
?ste????? Spasµ??

S?????? µp??st? se ?????
?et? stress
?s?µµet?e? ????se??
?e? p?ft???, de ?t?p???, de da??????? t? ???ssa
t???
T?µ???ta? ?t? e?p????e ?at? t?? ???s?

101
??t?µ?s? ep???pt???? spasµ??

?????e?a
??a???
a??a
t?a?µa
?pt???? d?ata?a???
???sfat? ?a? pa?a?? ?st?????

102
F?s??? e??tas?

??de??e?? t?a?µat??
??de??e?? a?????
??????µa, a??e???? d?s?aµ??a
???
????te?a

103
??t?µet?p?s? as?e???? µe ep???pt??? ???s?

?e? t?? eµp?d???
?e? ß??? ??t? st? st?µa t??
?? µp??? ?????? ???????
?a?a??????? µe ??G
??asfa???? a??e?a?? p??sßas?

104
(No Transcript)
105
Status Epilepticus

Se ?p?????a?µ?a
Dextrose 50 12.5 - 25 grams IV push
Te?aµ??? 100 mg IV push
??a?ep?µ? a??? IV ??? ?t?? e?e?????? ?? spasµ?? ?
??? d?s?? 10 mg
S?????? se d?se?? 2.5 mg d?ad?????
(phenytoin) 18mg/kg 25 mg/min
fa???ßa?ß?t???, 100 mg/min IV push ??? s????????
d?s?? 390 mg ? ??? ?t?? e?e?????? ?? spasµ??
?a?ß?t?????? ??µa
??????as? ?a? d?as?????s?

106
S??d??µ? Guillain Barre

??e?a µeta???µ?d?? p????e???p??e?a
???sß??? pe??fe????? ?e?????? s?st?µat??
??e?a a?t????s?? f?e?µ???d??
?atast??f? pet???? µ?e????? p?? ?a??pt??? ta
?e??a
????de?t??? s?µµet???? ap??e?a ????t????
?e?t?????a?
5 p??a??t?ta ?a??t??

107
???????? µ??f??

4 t?p??
1. a????sa
2. aµ???? ????t???
3. ?at???sa
4. s??d??µ? Miller Fisher

108
?pe????ta ???e???e????????? p??ß??µata

???? a?e???sµat?? ?????a??? a??t??

109
???? a?e???sµat?? ?????a??? a??t??-ep?pt?s?

?? 9? a?t?? ?a??t?? se ???
15.000 pe??stat??? et?s??? se ???
T??t?t?ta se ???? gt90
T??t?t?ta se epe???? ?e??????e?? 50
T??t?t?ta se p????aµµat?sµ??? ?e??????e?? 1-5

110
?a?????te? ???d????-????µ? d?????s?

?????a
F???
??p??sµa
?????e?e?a?? ?st?????

?? 75 t?? a?e???sµ?t?? as?µpt?µat???. Screening
µe US CT a??e????af?a
111
(No Transcript)
112
??????? ?????a ?????

??as??? ????da
??? ?????a?? ?a? ?sf???? ?????
shock
???af?t? ?????a?? µ??a
?p?p??s?eta
ta???a?d?a
ef?d??s?
?????a?? d??tas? / e?a?s??s?a
p???? st? ????

113
??t?µet?p?s? sta ???

?????? de??t?? ?p???a?
???µ?s? ??
?pe?????st???? ??e????
???t?????? d??s?s??
?e????????? pa??µßas?

114
???t?????? d??s?s??

F?eß??? p??sßas?, d?asta???s?
??????s? ???sta???e?d?? d?a??µ?t??
µet????s?
St???? ??, CVP, d?????s?

115
?pe????sa ??????s?

?a?????te? ???d????
?????a gt76
??eat????? gt1,9
Hgb lt9
ep??easµ??? ep?ped? s??e?d?s??
??G ?s?a?µ?a
pa?atetaµ??? shock
eµpe???a ?e????????

116
?ete??e???t???? ep?p?????

SIRS / MOF
S??d??µ? d?aµe??sµat??
?s?a?µ?a e?t????
?e?????sµ?? pe??fe????? ?????f???a?

117
(No Transcript)
118
???a s?µß?µata t?? ???s??
???e??aµ??a ???aµ??a S??d??µ? HELLP
119
???e??aµ??a

??ata?a?? s?et???µe?? µe t?? ???s?, p??
?a?a?t????eta? ap? ?p??tas?, p??te??????a ?a?
??d?µa ??t? ?????, s?????? µet? t?? 20? eßd?µ?da
t?? ???s??.

120
???aµ??a

? p??e??aµ??a p?? ep?p???eta? ap? spasµ???

121
??????s? p??e??aµ??a?

?p??tas?- S?? gt 140mmHg
? gt 30mm ??? t?? sta?e???
d?ast????? gt 90 mmHg
? gt 15mm ??? t?? sta?e???
??? d?af??et???? µet??se??, se d?? pe??pt?se??
µe d?af??? 6 ???? µeta?? t???.

122
?p?pt?s?

p??e??aµ??a 6-8 t?? ???se??
e??aµ??a 0,05-0,2
??t???? ???t?t?ta 8-36, s?????? ?fe???µe?? se
spasµ???
?µß????? 13-30, s?????? ???? ?at???e????
p?????t?ta?

123
?a??f?s??????a

????st?? ? a???ß?? µ??a??sµ??
???a?? a?t?a
d?s?e?t?????a eµß???p?a????t?a??? a??e?a???
???t?? µe a??e??s?spas?, ?????s? a?µ?peta???? ?a?
?pe?p??t???t?ta

124
??????? ?????a