2-004-05. Disease of nervous system : Decision-making General part

2-004-05. Disease of nervous system :  Decision-making General part

**Centent(목차) **
Headache c fever
Syncope(IM)
Sensation of rotary movement(ENT)
Unarousable unresponsiveness(NR)

l  Disease of nervous system

Headache c fever

Headache

                      |

           : consider, meningitis

Sore throat

                      |

           : consider,

           CVAT or urinary Sx / cystitis Hx

                      |

           : consider,

           Cough/Sputum

                      |

           : repeat exam    

           Brudzinski / Kernig

                      |

           Fever work-up 위해 admission 권유

Syncope(IM)

           Syncope

                      |

           Full recovery                 N –à coma protocol

                      | Y

           V/S,                                       - unstable à cardiogenic으로 간주

Any sign of Hypotension or hypoperfusion

                      |

           12-lead ECG                            

ECG 상 any abN w NSSTE             - CIM

           Or History of CHF, Ventricle dysrhythmia

                      |

           : consider,

           Seizure, hemiplegic

                      |

           : Age < 45

           Drug list review

           Stand BP check

           Autonomic Sx, predisposed condition        Y         – hydration

                                                                              Reassurance

                                                                              Scheduled OPD F/U

                      | N

           Careful history & exam

           Admission 권유

Sensation of rotary movement(ENT)

Sensation of rotary movement (rotary or non-rotatory)

                      |

           : true? Problem of space and object          N         - àgo other protocol

                                                                              Lightheadness

                                                                              Faintness

                                                                              Feeling of fullness on head

                                                                              Visual disturbance

                      |

           : 12 lead-ECG

           If, sign of ischemia?                              - cardiogenic R/O

                      |

           Drug list review

           Stand BP check

           Consider, anxiety, hyperventilation            - reassurance, discharge

                      |

           Clear-cut positional nystagmus                 - 이석정복술 시행

           Hearing loss

           Any cochlear Sx

                      |

           Anyway, need brain image(MRI NR admission 권유)

Unarousable unresponsiveness(NR)

Unarousable unresponsiveness(coma, drowsy, decrease mentality)

                      |

           BP/HR/RR/BT/SpO2/BST   - hypo, hyperglycemia, H+ problem

à metabolic (ABGA 포함)

           12lead ECG                              If, Unstable à shock protocol

           ABGA                                     any ECG abN w NSSTE à r/o cardiogenic

                                                        Any sign of infection à brain CT와 함께 chest APCT

                      |

           Brief neurologic asymmetics         if hemiplegic – R/O CVA

                      |

           Mental status re-evaluation          if, confusion or agitation – behavior protocol

                      |

           Repeat history & exam

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