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9 results

  • 14 - Status Epilepticus

  • from Section 3 - Neurological Emergencies
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 124-130

  • Summary

    • In generalized convulsive status epilepticus (GCSE), a seizure lasts longer than 5 minutes or two seizures occur without an interval return to baseline.

    • The most common error in managing status epilepticus is not administering enough benzodiazepine. If the patient is refractory to benzodiazepines, there are multiple appropriate agents for second-line treatment (e.g., levetiracetam, valproate, fosphenytoin). A timely and early intubation may be the safest option and provide the best outcome for the patient.

    • Nonconvulsive status epilepticus (NCSE) presents without muscle involvement, and may be suspected clinically, but needs electroencephalography (EEG) to make the diagnosis.

  • 13 - Intracranial Hemorrhage

  • from Section 3 - Neurological Emergencies
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 114-123

  • Summary

    • Intracranial hemorrhage (ICH) occurs when blood occupies space within the calvarium. ICH irritates brain parenchyma and impairs outflow of cerebral spinal fluid (CSF) from the dural sinus venous network, which raises intracranial pressure (ICP) with a resultant decrease in cerebral perfusion.

    • ICH types are defined by the location of the bleeding: intracerebral (within the parenchyma), epidural (between the skull and the dura), subdural (between the dura and arachnoid membrane) and subarachnoid (between arachnoid membrane and pia mater).

    • The skull is inelastic, so blood accumulation increases intracranial pressure.

  • 18 - Status epilepticus

  • from Section 3 - Neurological emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 130-133

  • Summary

    This chapter discusses the diagnosis, evaluation and management of severe traumatic brain injury (TBI). Early intubation is indicated in all severe TBI patients, and pretreatment may help minimize increase in intracranial pressure (ICP) during intubation. All severe TBI patients should have a neurosurgical evaluation early in their ED course. If the patient has a seizure, treatment and loading with 1g of phenytoin or fosphenytoin is indicated. The decision to place invasive ICP monitoring should generally be made in conjunction with neurosurgery. The indications for invasive ICP monitoring (external ventricular drain or intraparenchymal monitor) include severe TBI and a computed tomography (CT) showing hematomas, contusions, swelling, herniation, or compressed basal cisterns. Propofol or pentobarbital coma may be induced for severe, but nonsurgical TBI. The goal is to reduce cerebral activity and oxygen demand. These agents cause hypotension and decreased cerebral perfusion pressure (CPP) and should only be initiated with neurosurgical input.