Meningitis is present in the patient, which may often be determined by lumbar puncture. Severe neck stiffness that causes the patient's hips and knees to flex when the neck is bent is known as the Brudzinski sign. The irritation of the meninges is to blame for this. When assessing meningitis, blood cultures and CAT scans of the chest, abdomen, and pelvis are useless diagnostic tools. Even though the ESR is a general indicator of inflammation, it may be increased.
The Cushing trio is the physiological nervous system's reaction to persistently elevated intracranial pressure (ICP), and it is defined as erratic breathing, bradycardia, and hypertension. The average ICP is 20 mm Hg. It signals an upcoming herniation. Alterations in mental status, fixed or uneven pupils, nausea, vomiting, headaches, and seizures are some additional indications and symptoms that may be present.
Trigeminal neuralgia is an impingement of the trigeminal nerve, sometimes known as the facial nerve, which results in sporadic, extremely painful facial stimulation. Even something as easy as chewing gum, applying cosmetics, munching on a crunchy food, or consuming a cold beverage could make this sensation worse.
In any circumstance, maintaining the airway is crucial. Although not all postictal patients require intubation, short-term breathing assistance may be required if the patient is extremely sluggish until their neurological condition returns to normal. Once the patient has stabilized, an electrocardiogram can be done. The need for a central line is not necessary if the patient has enough peripheral access. An interosseous line can be inserted in the interim if the patient doesn't have sufficient access and the medical staff is unable to implant a peripheral line. It may not be necessary to perform a lumbar puncture depending on the seizure's presumed cause.
Because the patient's ICP is high and the drain isn't working, calling the attending, resident, or physician's assistant on call is appropriate. There might be a clot in the drain, and it might or might not need to be flushed (the nurse shouldn't do this). There are further reasons why a drain might not be functioning, and the attending will decide what to do next. An acceptable ICP range is 0 to 20. Monitoring an ICP over 30 without calling an attending is inappropriate because it could result in lasting brain damage.
Antiplatelet drugs like aspirin and ticagrelor can raise the chance of severe bleeding. To assist avoid thromboembolic events, they stop cells from clotting together too quickly. Patients should be instructed to see a doctor right away if they observe persistent heavy bleeding.
Osmotic diuretics like mannitol are used to assist lower ICP. Ischemia of the entire brain and eventual brain death can result from a persistently increased ICP. Since the brain contains 80% water, treatments like hypertonic saline and osmotic diuretics reduce pressure and prevent additional injury by drawing cerebrospinal fluid and fluid from the wounded brain.
