Chapter 24 Neurological emergencies
COMA OR IMPAIRED CONSCIOUSNESS
Impaired consciousness is recognised and described by observation of response to sound, light, touch or painful stimulus. The Glasgow Coma Scale (GCS) gives a standard way of recording and monitoring the level of consciousness (see Chapter 15, ‘Neurosurgical emergencies’).
Examination
Investigations
EPILEPSY
Fits are usually self-limiting and no urgent drug treatment is needed. During fits:
After the fit, ask if there is a history of fits.
Prolonged fitting or frequent fitting (status epilepticus)
Partial seizures may be prolonged or frequently recurrent without major hazard.
Major generalised seizures lasting more than 5–10 minutes or recurring rapidly are life-threatening. This situation demands prompt and adequate IV drug therapy, monitoring and support.