Lecture 5 - Neurological Emergencies
Questions and Answers|Latest Update
Head injuries Hypoxia addressed first (most common cause of death)
Control any bleeding and treat shock
Frequent exam of vital signs and neurological signs (These signs can change within minute to
minute)
Deterioration in neurologic signs indicates edema (increase ICP (intracranial pressure), anoxia
and impending brain stem herniation = Treat with Mannitol (0.25 g/kg IV over 5-10 minutes)
Mannitol reduces intracranial pressure by relieving edema in the tissue. hypertonic solution ->
higher concentration of solution ex: PLA. hypotonic (lower concentration like water)
mannitol will suck fluid out of the tissues (like the brain) and try to remove it out of the body.
Opisthononic position Characterized by both forelimb and hind limb rigidity, head and
neck arched backward
Most often seen with dramatically increased ICP leading to brain stem herniation (brain tissue
forced from it's normal anatomic position)
If not treated immediately herniated brain tissue may put pressure on the nervous control
centers for breathing with possible apnea
,What do animals look like when they are going to herniate their brains? stretched out
both hind and front limbs with their heads stretched upwards and backwards. If you don't treat
this immediately, they end up with respiratory arrest and/or cardiac arrest
Treatment/
balancing act Treating the systemic injury and not the brain specifically often results in
reduced ICP and improved neurological outcome
Hypotention is the cause of ongoing secondary brain trauma causing ischemia and hypoxia,
therefore the hypotention must be treated without increasing ICP
Cerebral Perfusion = MAP - ICP, therefore maintaining normal MAP decreases chances of
ischemic injury
Avoiding hypertension is equally important
Crystalloids/Colloids/ Blood products (other trauma leading to anemia)
What happens when treating with fluids for hypotension? You increase their intracranial
pressure. Therefore....monitor for Cerebral perfusion.
, Mannitol reduces ICP and blood viscosity increasing cerebral profusion (used as bolus).
sucks all excess in the brain and sends it to the vasculature...this will increase BP. You can to help
get the body rid of this excess fluid is what Furosemide does..
Furosemide May help to reduce ICP further, given after Mannitol. Both must be used
carefully to avoid dehydration and hypotension (suck and dump too much = hypotension and
dehydration again)
Furosemide DUMPs all the excess fluid.
Treatment of Head Injuries continued Mechanical Ventilation may be required
Seizures may arise and should be controlled:
Diazepam 0.5 mg/kg IV boluses, +/- CRI
Phenobarbital CRI
Propofol CRI
IV fluid support must be maintained and closely monitored
Questions and Answers|Latest Update
Head injuries Hypoxia addressed first (most common cause of death)
Control any bleeding and treat shock
Frequent exam of vital signs and neurological signs (These signs can change within minute to
minute)
Deterioration in neurologic signs indicates edema (increase ICP (intracranial pressure), anoxia
and impending brain stem herniation = Treat with Mannitol (0.25 g/kg IV over 5-10 minutes)
Mannitol reduces intracranial pressure by relieving edema in the tissue. hypertonic solution ->
higher concentration of solution ex: PLA. hypotonic (lower concentration like water)
mannitol will suck fluid out of the tissues (like the brain) and try to remove it out of the body.
Opisthononic position Characterized by both forelimb and hind limb rigidity, head and
neck arched backward
Most often seen with dramatically increased ICP leading to brain stem herniation (brain tissue
forced from it's normal anatomic position)
If not treated immediately herniated brain tissue may put pressure on the nervous control
centers for breathing with possible apnea
,What do animals look like when they are going to herniate their brains? stretched out
both hind and front limbs with their heads stretched upwards and backwards. If you don't treat
this immediately, they end up with respiratory arrest and/or cardiac arrest
Treatment/
balancing act Treating the systemic injury and not the brain specifically often results in
reduced ICP and improved neurological outcome
Hypotention is the cause of ongoing secondary brain trauma causing ischemia and hypoxia,
therefore the hypotention must be treated without increasing ICP
Cerebral Perfusion = MAP - ICP, therefore maintaining normal MAP decreases chances of
ischemic injury
Avoiding hypertension is equally important
Crystalloids/Colloids/ Blood products (other trauma leading to anemia)
What happens when treating with fluids for hypotension? You increase their intracranial
pressure. Therefore....monitor for Cerebral perfusion.
, Mannitol reduces ICP and blood viscosity increasing cerebral profusion (used as bolus).
sucks all excess in the brain and sends it to the vasculature...this will increase BP. You can to help
get the body rid of this excess fluid is what Furosemide does..
Furosemide May help to reduce ICP further, given after Mannitol. Both must be used
carefully to avoid dehydration and hypotension (suck and dump too much = hypotension and
dehydration again)
Furosemide DUMPs all the excess fluid.
Treatment of Head Injuries continued Mechanical Ventilation may be required
Seizures may arise and should be controlled:
Diazepam 0.5 mg/kg IV boluses, +/- CRI
Phenobarbital CRI
Propofol CRI
IV fluid support must be maintained and closely monitored
