Kegawatan SSP Pada Keracunan

Andi Basuki, dr, Sp.SBagian Ilmu Penyakit Saraf

FK UNPAD – RS HASAN SADIKIN

Neurotoxic injuries

- Occupational

- Accident

- Abuse

Exposure

- Inhalation

- Digestion

- Direct Contact : Skin, Mucosa

Time to exposure

- ACUTE

- CHRONIC

EFFECTS of NEUROTOXIC AGENTS

- CNS EXITATION

- PNS INHIBITION

Neuro Emergency Toxins Exposure ( Acute, Chronic )

CNS PNS

Encephalopathi Muscle spasm / Tetani Coma Muscle Paralysis Seizures Polyneuropathi Autonomic Dysfunc Autonomic Dysfunc

Death ( Brain Death )

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

Life Threatening

1. Encephalopaty Decrease LoC

2. Seizures Status Convulsivus

3. Neuro/Myopaty Respiratory Failure

4. Autonomic Storm Dysautonomia

Drugs/Toxins Causing Ventilatory Failure

Muscle Paralysis Central Drive Depression - Botulinum - Barbiturat - Neuromusc. Blockers - Sympatolytic agents - Organophospate - Cyclic antidepresants - Carbamate - Ethanol, alcohols - Snake bite - Opiates - Strychnine - Sedative – hypnotics - Tetanus

Follow Up

A R A S Decrease LoC

GCS ( 3 – 15 ) E = 1 – 4 M = 1 – 6 V = 1 – 5 Compos Mentis = 15 Somnolen = 12 – 14 Sopor = 8 – 11 Coma = 3 – 7

Status Convulsivus

Def : - Seizure lasting more than 30 Minutes

- More than 1 seizure, without improvement of LoC in Between

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

Supporting Examination

NeuroPhysiologi

1. EEG

2. EMG - NCS

Brain / Brain Stem Dysfunction

Brain Death – Brain stem Death

Brain Stem Examination - CN II – III - CN III – IV – VI - CN V – VII - CN VII - CN IX –X

CN II - III

Light Reflex Direct - Indirect Afferent : N. II Efferent : N. III

CN III – IV - VI Eye Movement - Doll’S Eye ( Oculocephalic )

- Caloric Test ( Oculo vestibuler )

CN V - VII

Corneal Reflex - Afferent : N. V

- Efferent : N. VII

CN. VII

Facial motorik

- With Pain : Grimace

CN IX - X

Gag Reflex - Suction in Intubation Patient