Scottish Intensive Care Society
ICM Induction programme ©
Central Nervous System |
Diminished conscious level |
Threatened airway |
Absent gag/cough |
Failure to maintain normal PaO2 and PaCO2 |
e.g. Status epilepticus |
Peripheral Nervous System |
Bulbar symptoms: unable to clear saliva, impaired swallowing |
Poor cough |
Failure to maintain normal PaCO2 and PaO2 |
Examples are Guillain Barre syndrome, Myasthenia Gravis,
muscular dystrophies |
Table 1. Features of central and peripheral neurological failure.
Neurological emergencies
Neurological failure can be classified by site into central and peripheral. This affects the way in which patients present to intensive care (Table 1).
General principles
The patient with acute neurological disease should be assessed and treated using the ABCDEF approach as in the Assessment tutorial. You should work through that before carrying on with this tutorial
For the purposes of this tutorial it is a given that appropriate airway, ventilation, cardiovascular assessment, treatment and support are in place.
Any patient presenting with agitation, confusion or reduced conscious level must have a blood sugar measured and hypoglycaemia treated
Neurological disease may be due primary diseases of the nervous system or a manifestation of systemic disease. It is vital to secure a diagnosis and this requires a systematic approach
Primary insults causing CNS compromise may involve a number of anatomical and physiological aberrances
-Blood and blood vessels: haemorrhage or thrombosis, hypo-perfusion or no perfusion
-Cerebral tissue: oedema, inflammation, trauma, effects of raised intra-cranial pressure (ICP)
-CSF: infection, obstruction (hydrocephalus)
-Electrical activity: seizures, depression eg drugs
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