Page 179 - Critical Care Notes

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■ Avoid restraining the patient.
■ Avoid forcing airway into patient’s mouth when jaws clenched.
■ Avoid use of tongue blade.
■ Maintain patent airway during seizure.
■ During postictal state (after seizure):
■ Assess vital signs closely; provide ECG monitoring.
■ Monitor oxygenation and respiratory status (ABGs, SpO 2 , breath
sounds).
■ Turn patient to side-lying position; administer O 2 therapy; suction prn.
■ Check level of orientation and ability to speak (patient usually sleeps
afterward).
■ Note headache and signs of increased ICP.
■ Check pupil size, eye deviations, and response to auditory and tactile
stimuli.
■ Note paralysis or weakness of arms or legs.
■ Keep oral or nasal airway or ETT at bedside.
■ Ensure patient’s safety (pad side rails, bed at lowest position).
■ Prevent Wernicke-Korsakoff syndrome; administer thiamine 100 mg IV
and 50 mL of 50% glucose if chronic alcohol ingestion or hypoglycemia
is present.
■ Surgery may be indicated in select cases.
Neurosurgery
Indications include tumors, AVMs and aneurysms. Craniotomy is the most com-
mon procedure. Others include stereotactic biopsy and neuroendoscopy.
Complications
■ Neurological deficits: some may be expected, others not
■ Cerebral edema, increased ICP, hydrocephalus, CSF leak
■ Vasogenic edema
■ Cerebral infarction
■ Seizures
■ Pneumocephalus
■ Infections: wound, meningitis, abscesses
■ Hemorrhage
■ Hyponatremia and electrolyte imbalances such as SIADH, cerebral salt
wasting
■ DVT and pulmonary embolism

NEURO