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Neurologic vs Systemic
-neurologic: focal sign, rapid onset, truama
-Systemic: progressive, medication, fever
各次專科想一遍
medication/toxin
psychiatric
with focal signs
stroke, ICH, VST, PRES, pituirtary apoplexy
meningitis, encephalitis, abscess
TBI, concussion
Alzheimers, CJD
from uptodate
from sematic scholar
A Alcohol, Anemia 酒精、貧血
E Electrolyte imbalance (NaCaMg) 電解質不平衡
I Insulin 高低血糖
O opiates, Oxygen (hypoxemia) 嗎啡類藥物, 低血氧
U Uremia 尿毒症
T Trauma, temperature, tumor 外傷, 體溫, 腫瘤
I Infection (meningitis, encephalitis, sepsis) 感染
P Psychogenic 精神因素
S Seizure, Stroke 癲癇, 中風
1. LQQ OPERA: tempo, premobid sx
2. Meds
3. ABC
4. Past/personal/family/OP history
5. TOCC
from uptodate
1. Empirical Abx
2. Thiamine 100mg IV=> dextrose 50g IV
(naloxone 0.01mg/kg, flumazenil 0.2mg)
3. If C spine fracture=>immobilization
4. Head trauma四寶: mannitol, tranexemic acid, anti-epileptics, codeine
5. If tumor edema: dexamethasone 1pc IV and Q6H
All patient:
1. 血液: CBC/DC
2.biochemistry: BUN/Cr, Na/K/Ca/Mg, sugar, liver function test, toxin, ABG
3.Urine: urine routine, toxin
If clinical suspicion:
1. hepatic encephalopathy: ammonia
2. thyroid storm/ myxedema: TSH, free T4
3. adrenal insufficiency: cortisol
4. Wernicke encephalopathy: Vit B12
5. HIV combo test
6. SLE encephalopathy: ANA
7. infection: B/C
8. neurologic sign: brain CT C(-)
9. CNS infection: lumbar puncture
10.non-convulsive seizures: EEG
1. Treat the underlying disease
2. stimulation and good sleep
3. prevent infection, restraint
4. Anti-psychotics if need