Page 176 - Critical Care Notes

4223_Tab05_141-174 29/08/14 8:28 AM Page 170

NEURO
■ Assess vascular function for signs of septic emboli.
■ Ensure ↓ environmental stimuli, quiet environment, and ↓ exposure
to lights.
■ Administer corticosteroids to decrease inflammation: dexamethasone.
■ Administer anticonvulsants for seizures: phenytoin, phenobarbital,
lorazepam.
■ Administer antipyretics for fever.
■ Administer analgesia for headache.
■ Administer hyperosmolar agents for cerebral edema: mannitol and diuretics:
Lasix.
■ Insert surgical shunt if hydrocephalus is present and adjust antibiotic therapy
per the causative agent and antibiotic sensitivity.
■ Consider the following antibiotic therapy:
■ Cefotaxime (Claforan)
■ Ceftazidime (Ceptaz, Fortaz)
■ Ceftriaxone (Rocephin)
■ Vancomycin
■ Meropenem (Merrem)
Assess CSF analysis, Gram stain, and cultures for antibiotic sensitivity.
Seizure Disorder
A seizure disorder is a temporary, abnormal, sudden, excessive, uncontrolled
electrical discharge of neurons of the cerebral cortex. Status epilepticus (SE),
which denotes continuous seizure activity (lasting >5 min or two or more
sequential seizures), is a medical emergency.
Pathophysiology
Repetitive depolarization of hyperactive hypersensitive brain cells → abnormal
electrical activity in the brain.
Risk factors for seizure disorder include:
■ Epilepsy
■ Drug or alcohol abuse
■ Drug toxicity (aminophylline)
■ Recent head injury
■ Infection
■ Headache
■ Acute metabolic disturbances (hypoglycemia, hyponatremia, hypocalcemia,
renal failure)
■ CVA
■ CNS infection (meningitis, encephalitis)
170