Kegawatan SSP Pada Keracunan

Andi Basuki, dr, Sp.S Bagian Ilmu Penyakit Saraf FK UNPAD – RS HASAN SADIKIN

Neurotoxic injuries
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Occupational

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Accident
Abuse

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Exposure  . Mucosa  .Digestion .Direct Contact : Skin.Inhalation  .

Time to exposure  .CHRONIC  .ACUTE .

CNS EXITATION  .EFFECTS of NEUROTOXIC AGENTS  .PNS INHIBITION .

Chronic ) CNS  PNS Muscle spasm / Tetani Muscle Paralysis Polyneuropathi Autonomic Dysfunc    Encephalopathi Coma Seizures Autonomic Dysfunc  Death ( Brain Death ) .Neuro Emergency  Toxins Exposure ( Acute.

Brain Stem Sign : .ABC ( Vital Sign ) .Physiological : Decrease – Increase .anisocor .Refleks .Eye Movement : Doll’s eye .Level of Consciousness ( LoC ) = GCS .Negative .Pupil : isocor .Light reaction : direct – indirect .Postural : Decortication – Decerebration .Follow Up           .Pathological : Positive .

Life Threatening  1. Encephalopaty 2. Autonomic Storm  Dysautonomia . Neuro/Myopaty  Decrease LoC  Status Convulsivus  Respiratory Failure    4. Seizures 3.

Blockers .Cyclic antidepresants . alcohols .Neuromusc.Snake bite .Barbiturat .Tetanus .Strychnine .Sedative – hypnotics .Ethanol.Sympatolytic agents .Drugs/Toxins Causing Ventilatory Failure         Muscle Paralysis Central Drive Depression .Carbamate .Opiates .Organophospate .Botulinum .

Follow Up     ARAS  GCS ( 3 – 15 ) E = 1–4 M = 1–6 V = 1–5 Compos Mentis Somnolen Sopor Coma Decrease LoC      = 15 = 12 – 14 = 8 – 11 = 3–7 .

Status Convulsivus   Def : .Seizure lasting more than 30 Minutes   . without improvement of LoC in Between .More than 1 seizure.

Diazepam 10 mg iv ( Could be repeated in 10 -15 minutes ) .Fenitoin 15 – 20 mg / kg iv ( not faster than 50 mg / mnt ) .Status Convulsivus         Management .Knock Down in ICU ( Pentobarbital 5 – 6 mg/kg slow iv ) .ABC .

Supporting Examination  NeuroPhysiologi 1. EEG 2.NCS   . EMG .

CN III – IV – VI .CN IX –X .CN II – III .CN V – VII .Brain / Brain Stem Dysfunction Brain Death – Brain stem Death       Brain Stem Examination .CN VII .

CN II . III .III    Light Reflex  Direct . II Efferent : N.Indirect Afferent : N.

Doll’S Eye ( Oculocephalic ) .CN III – IV .Caloric Test ( Oculo vestibuler )  .VI   Eye Movement .

VII   Corneal Reflex . VII  . V .Afferent : N.CN V .Efferent : N.

CN.With Pain : Grimace . VII  Facial motorik  .

Suction in Intubation Patient .X   Gag Reflex .CN IX .

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