Stabilisation of the emergency patient. Part III: Central nervous system.

The emergency patient with decreased consciousness is identified by clinical examination of pupil size and reaction, additional brain stem reflexes, level of consciousness and motor activity. Priority stabilisation of respiration and perfusion is mandatory in the management of patients with neurological diseases and is part of the strategy aiming at preventing secondary neuronal damage induced by hypoxia, hypercapnia and decreased cerebral perfusion. The goal of the emergency stabilisation is maintenance of normal ventilation and oxygenation as well as keeping mean arterial blood pressure above 70 mm Hg. Hypertonic saline, Mannitol and sedation may be indicated with signs of increased intracranial pressure. Seizures must be treated immediately and some patients may require anaesthesia and positive pressure ventilation.