Kegawatan SSP Pada Keracunan

Andi Basuki, dr, Sp.S Bagian 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
Muscle spasm / Tetani Muscle Paralysis Polyneuropathi Autonomic Dysfunc

Encephalopathi Coma Seizures 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 : Dolls eye - Refleks - Postural : Decortication Decerebration - Physiological : Decrease Increase - Pathological : Positive - Negative

Life Threatening

1. Encephalopaty
2. Seizures 3. Neuro/Myopaty

Decrease LoC
Status Convulsivus 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

ARAS GCS ( 3 15 ) E = 14 M = 16 V = 15 Compos Mentis Somnolen Sopor Coma

Decrease LoC

= 15 = 12 14 = 8 11 = 37

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 - DollS 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