kegawatan ssp pada keracunan.ppt
DESCRIPTION
Materi SeminarTRANSCRIPT
Kegawatan SSP Pada Keracunan
Andi Basuki, dr, Sp.SBagian Ilmu Penyakit Saraf
FK UNPAD – RS HASAN SADIKIN
Neurotoxic injuries
- Occupational
- Accident
- Abuse
Exposure
- Inhalation
- Digestion
- Direct Contact : Skin, Mucosa
Time to exposure
- ACUTE
- CHRONIC
EFFECTS of NEUROTOXIC AGENTS
- CNS EXITATION
- PNS INHIBITION
Neuro Emergency Toxins Exposure ( Acute, Chronic )
CNS PNS
Encephalopathi Muscle spasm / Tetani Coma Muscle Paralysis Seizures Polyneuropathi Autonomic Dysfunc Autonomic Dysfunc
Death ( Brain Death )
Follow Up - ABC ( Vital Sign ) - Level of Consciousness ( LoC ) = GCS - Brain Stem Sign : - Pupil : isocor - anisocor - Light reaction : direct – indirect - Eye Movement : Doll’s eye - Refleks - Postural : Decortication – Decerebration - Physiological : Decrease – Increase - Pathological : Positive - Negative
Life Threatening
1. Encephalopaty Decrease LoC
2. Seizures Status Convulsivus
3. Neuro/Myopaty Respiratory Failure
4. Autonomic Storm Dysautonomia
Drugs/Toxins Causing Ventilatory Failure
Muscle Paralysis Central Drive Depression - Botulinum - Barbiturat - Neuromusc. Blockers - Sympatolytic agents - Organophospate - Cyclic antidepresants - Carbamate - Ethanol, alcohols - Snake bite - Opiates - Strychnine - Sedative – hypnotics - Tetanus
Follow Up
A R A S Decrease LoC
GCS ( 3 – 15 ) E = 1 – 4 M = 1 – 6 V = 1 – 5 Compos Mentis = 15 Somnolen = 12 – 14 Sopor = 8 – 11 Coma = 3 – 7
Status Convulsivus
Def : - Seizure lasting more than 30 Minutes
- More than 1 seizure, without improvement of LoC in Between
Status Convulsivus Management - ABC - Diazepam 10 mg iv ( Could be repeated in 10 -15 minutes ) - Fenitoin 15 – 20 mg / kg iv ( not faster than 50 mg / mnt ) - Knock Down in ICU ( Pentobarbital 5 – 6 mg/kg slow iv )
Supporting Examination
NeuroPhysiologi
1. EEG
2. EMG - NCS
Brain / Brain Stem Dysfunction
Brain Death – Brain stem Death
Brain Stem Examination - CN II – III - CN III – IV – VI - CN V – VII - CN VII - CN IX –X
CN II - III
Light Reflex Direct - Indirect Afferent : N. II Efferent : N. III
CN III – IV - VI Eye Movement - Doll’S Eye ( Oculocephalic )
- Caloric Test ( Oculo vestibuler )
CN V - VII
Corneal Reflex - Afferent : N. V
- Efferent : N. VII
CN. VII
Facial motorik
- With Pain : Grimace
CN IX - X
Gag Reflex - Suction in Intubation Patient