Seizure Management and CNS Infections Algorithm

Study Notes

Seizure Management Algorithm

The flowchart shows the steps to manage seizures based on duration and IV access.
If a seizure lasts longer than 5 minutes, proceed to Step 2.
If a seizure lasts less than 5 minutes, administer buccal midazolam or rectal diazepam.
Step 2: Assess for IV access.
If access is established, proceed to Step 3.
If access is not established, administer buccal midazolam or rectal diazepam.
Step 3: Administer Lorazepam IV if the seizure continues.
If the seizure continues after the first dose of Lorazepam, administer a second dose.
If the seizure continues after the second dose of Lorazepam, administer Phenytoin IV or Phenobarbital IV.
Step 4: If IV access is not established and the seizure continues, administer buccal midazolam or rectal diazepam.

Central Nervous System Infections

Out-of-hospital meningitis is treated with Benzylpenicillin.
In-hospital meningitis is treated with Cefotaxime IV or Ceftriaxone IV.
Listeria meningitis is treated with Amoxicillin + Gentamicin.
Cryptococcal meningitis is treated with Amphotericin B.
For meningitis prophylaxis, Ciprofloxacin is the first-line treatment, with Rifampicin as a second-line option.

Genitourinary Infections

Lower, uncomplicated UTIs are treated with Trimethoprim or Nitrofurantoin.
Upper UTIs, or Pyelonephritis, are treated with Cefalexin, co-amoxiclav, ciprofloxacin, or trimethoprim.
Candida albicans (Vulvovaginal Candidiasis) is treated with Clotrimazole or Fluconazole.
Trichomonas vaginalis is treated with Metronidazole.
Cervicitis caused by Chlamydia is treated with Doxycycline as the first-line treatment, with Azithromycin being the second-line option or used in pregnant women.
Cervicitis caused by Gonorrhea is treated with Ceftriaxone IM or Ciprofloxacin if sensitivity is known.
Pelvic inflammatory diseases are treated with Ceftriaxone + Metronidazole + Doxycycline as the first-line treatment.
Syphilis is treated with Penicillin G.
Genital herpes (HSV) is treated with Aciclovir.

Skin, Joint and Other Infections

Cellulitis, Mastitis, and Diabetic Foot infections are all treated with Flucloxacillin.
Scabies is treated with Permethrin 5% topical.
Septic Arthritis is treated with Flucloxacillin, with Vancomycin being the treatment option if MRSA is present.
Osteomyelitis is treated with Flucloxacillin, with Vancomycin being the treatment option if MRSA is present.
Toxoplasmosis is treated with Pyrimethamine + Sulfadiazine.

Side Effects of Anti-TB drugs

RIPES: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, Streptomycin
Side Effects of Rifampicin, Isoniazid, and Pyrazinamide
- Increased uric acid and risk of gout
- Peripheral neuritis, which can be treated with vitamin B6
- Hepatitis
- Red-orange urine and secretions
- Enzyme P450 induction
Side Effects of Ethambutol
- Visual problems, such as red-green discrimination issues and decreased visual acuity
- Optic neuritis
Side Effects of Streptomycin
- Ototoxicity
- Potential deafness
- Contraindicated in pregnancy

Gastrointestinal Infection

Salmonella infection can be treated with Ciprofloxacin or Cefotaxime.
Shigella or Campylobacter infections are treated with Erythromycin, Azithromycin, Clarithromycin, or Ciprofloxacin.
Clostridium difficile (Pseudomembranous colitis) is treated with Vancomycin as the first-line treatment.
Fidaxomicin is the second-line treatment if Vancomycin is ineffective.
If both Vancomycin and Fidaxomicin are ineffective, Vancomycin ± Metronidazole can be used.
Helicobacter pylori is treated with OAC or OAM:
- Omeprazole
- Amoxicillin
- Clarithromycin
- or Metronidazole

Superior Vena Cava Syndrome

Obstruction of the SVC by either tumour or clot
Presentation:
- Dilated superficial veins of the neck, arms, and anterior chest wall
- Oedema of the face, neck, and upper limbs
- Difficulty breathing
- Weight loss and smoking in case of cancer
Investigations
- Chest X-ray may reveal a tumour.
- Contrast-enhanced CT is the investigation of choice.
Management:
- Stenting or angioplasty
- Treatment of the specific cancer

MRI Cases

MRI Spine
- Malignant spinal cord compression
- Cauda equina syndrome
- Lumbar spinal stenosis
MRI Head
- Posterior circulation stroke
- Brain cancers (e.g., new onset seizure, headache, focal neurological deficit)
- Multiple sclerosis (MS)
- Meningitis
MRI Knee
- Anterior cruciate ligament (ACL) tears
- Meniscus tears
- Osteoarthritis
- Patellofemoral pain syndrome

Description

This quiz focuses on the algorithm for managing seizures and addresses treatment protocols for central nervous system infections. Participants will learn about the systematic approach to seizures based on duration and IV access, as well as effective medicinal treatments for meningitis. Enhance your understanding of critical emergency procedures in neurology.