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The Gist of Emergency Medicine - part 5

rung động tĩnh mạch tự phát ở vị trí nằm → không có tăng áp lực nội sọ. xác định học sinh → ma tuý, phenothiazin, hoặc quá liều clonidin, cholinergics?, gtts mắt miotic?, xuất huyết cầu não? (mắt nhấp nhô), tiểu não xuất huyết (miosis đảo ngược với narcan ® ma tuý cấp →? | The Gist of Emergency Medicine 77 IV. Central Nervous System first of two sections See also Central Nervous System second of two sections p. 125. 1 Locked-in syndrome CVA with destruction of the ventral pontine tracts patient appears to be in a coma but has vertical eye movement on command. 2 Cheyne-stokes breathing bilateral cerebral hemispheric disease Hyperventilation upper brain stem damage Apneustic breathing like breath holding lesion about 5th cranial nerve Cluster breathing short bursts lesion pons Yawning posterior fossa lesion Vomiting hiccuping and coughing lower brain stem injury 3 Fundi spontaneous venous pulsations in the recumbent position no increase in the intracranial pressure. pinpoint pupils narcotic phenothiazine or clonidine overdose cholinergics miotic eye gtts pontine hemorrhage ocular bobbing cerebellar hemorrhage miosis reversed with narcan acute narcotic withdrawal restrain patient first CT scan prn refer neurosurgery prn cerebellar hemorrhage needs immediate neurosurgical intervention . 4 If both eyes cross the midline the brain stem is intact. Doll s eyes movement present brain stem intact contraindicated in suspected cervical spine injuries. Oculovestibular testing no basilar skull fracture is suspected plus the Tm s must be intact external auditory canals are sequentially irrigated with 50cc of ice water bilateral nystagmus no coma hysterical eyes deviated towards side of irrigation brain stem intact no deviation brain stem damage drugs reactive pupils unilateral deviation structural damage of the brain stem CT scan refer neurosurgery . Central Nervous System The Gist of Emergency Medicine 78 5 Acute cerebellar hemorrhage headache alert vertigo vomiting unable to stand truncal ataxia progressing to coma decerebrate posturing pinpoint pupils eyes deviated away from the side of the lesion. L ABC s L hypertension prn and increased intracranial pressure prn immediate neurosurgical decompression also for traumatic posterior fossa .