tailieunhanh - How to Survive in Anaesthesia - Part 10

Đánh giá đáp ứng thần kinh đáp ứng tốt nhất của động cơ tuân theo lệnh rút từ tác nhân kích thích gây đau đớn khoanh vùng với các kích thích đau đớn gập với các kích thích đau đớn kéo dài đến kích thích đau đớn không có phản ứng bằng lời tốt nhất đáp ứng định hướng nhầm lẫn bài phát biểu không thể hiểu được những từ không thích hợp âm thanh không đáp ứng khai mạc mắt một cách tự nhiên để nói không đau. | emedicina Management of head injuries Table The Glasgow Coma Scale GCS . Neurological assessment Response Score Best Motor Response obeys commands 6 withdraws from painful stimuli 5 localises to painful stimuli 4 flexes to painful stimuli 3 extends to painful stimuli 2 no response 1 Best Verbal Response orientated 5 confused speech 4 inappropriate words 3 incomprehensible sounds 2 none 1 Eye Opening Response spontaneously 4 to speech 3 to pain 2 none 1 assessing neurological progress. A GCS 8 is serious and often an indication for endotracheal intubation. Further management of the head-injured patient includes the use of intravenous mannitol 0-5 g kg which decreases intracranial pressure transiently. Anticonvulsants may be necessary if seizures occur and antibiotics are used prophylactically in patients with compound skull fractures. Further advice can be obtained from the regional neurosurgical centre. Interhospital transfer Patients are often transferred for neurosurgery. The decision whether to operate or not depends on the CT scans of the brain. Guidelines for transferring head-injured patients are shown in Box . Intubated patients should not increase intracranial pressure during transfer by coughing or straining and hyperventilation is maintained. Short acting drugs such as propofol vecuronium and fentanyl allow further assessment of the patient at the neurosurgical centre. A detailed handover to the receiving anaesthetist at the neurosurgical centre is essential. 173 emedicina How to Survive in Anaesthesia Box Guidelines for transferring head-injured patients Physiological stabilisation before transfer Escorting doctor of adequate experience Appropriate drugs and equipment for transfer Intubated patients require sedation paralysis analgesia if indicated Use shor t acting drugs to allow neurological assessment Monitoring to minimal acceptable standard Conclusion The anaesthetist has a major role in the management of the head-injured patient and .