*** SEIZURES: 1% # CNS tumor & metastases, CVA, electrolyte abnormality, hypocalcema, hypoglycemia, drug, stopping anticonvulsants abruptly, sedative withdrawal, alcohol *Rx: ** Valium 5-10mg by slow IV/rectal stat ** Dilantin 1,000mg po in first 24 hours in 3-5 doses, followed by 300- po/day ** Dilantin, phenobarbital 100-200 IM ** Phenobarbital 30-60mg po BID-TID ** Dysphagic: Phenobarbital, Ativan, Valium IV/Rectal. ** Versed 0.25-2mg/hr by SQ pump C Diastat: Rectal valium pre-filled syringe • control seizures even in dying patients

*** ALS: • Respite care • Mentally alert until death • Choking is a rare cause of death <1% • Occupational therapy • Aids: walking, talking, eating, etc. • Dysphagia: ice to neck before meals • Suck ice before meals • eat slow • place food at the back of throat • Avoid dehydration • Repeated chocking: PEG • Drooling: ** Atropine, Scop-olamine, TCA (Elavil) • NO artificial ventilation • Good symptom management • Rilutek: very expensive, not a cure.

*** RAISED INTRA CRANIAL PRESSURE: # Wakes up with HA, nausea, projectile vomiting, papilloedema, focal neurologic deficit, mental status change (seizure)  Tumor, metastasis *Rx: ** High dose Decadron 16mg/d as 4 mg PO QID ** diuretics ** Head of bed elevated to 30-45°

*** BRAIN METS: 10% of Cancers # Focal Neuro deficit, Seizures, ã ICP, wakes up with HA, Vomiting, Papilloedema, Personality changes *Rx: ** High dose Decadron ** Radiation ** Anticonvuls-ants ** Surgery: Solitary accessible lesion, no other mets, healthier pt, not dying, good prognosis

*** SIADH: 1%  ca of lung small cell, ã water, decreased sodium # HA, fatigue, cramps, confusion, seizures, coma ** Fluid Restriction 500-900 cc/day ** Demeclocycline 300 mg PO BID A lasix *Rx the cause A monitor electrolytes A consider hypertonic saline infusion but avoid rapid correction

*** ALZHEIMER’S: • Most common cause of dementia • Cause: not known • Gradual decline in intellectual functioning, memory, concentration, behaviour, language • Early Stages: Treatment is available • Late Stages: Symptomatic Care, control behaviour, support caretakers

*** CONFUSION: # Drugs, metabolic & electrolyte abnormalities, Pain, Impaction, Brain Metastases, CVA, Infection, Alcohol, bladder distension j family members are worried more than the patient # confusion, disorientation, agitation *Rx: ** correct the cause • agitation / hallucination: ** Haloperidol ** Chlorpromazine, Risper-idol, Zyprexa ** Symptomatic care

*** DROWSINESS: # Morphine, Pyschotropic drugs, Hypercalcemia, Uremia, Electrolyte imbalance, Hyponatremia, Infection *Rx: ** Treat cause • pain free but drowsy: A ¤ morphine A Ritalin

*** CAUDA EQUINA SYND: # Involvement b/wL1 to the end • Lumbosacral nerves supply the lower extremities, bladder, rectum. • Interruption of S2, 3, 4 the bladder-emptying reflex causes retention # bilateral Sciatica • Perianal numbness (“saddle anaesthesia”), Urinary hesitancy or retention, Weak, flaccid legs • *Rx: ** Radio-therapy, ** high dose steroids ** Tricyclic ** lPhenothiazine ** Pain control ** Urinary Catheter

*** SPINAL CHORD COMPRESSIONS: 5% # pain, weakness / paralysis / decrease sensation / increased DTR below the compression; incontinence of bowel / bladder • W/U: x-ray, MRI, Myelogram (if needed), CT *Rx: ** immediate *Rx within 48 hours may restore the deficit ** High dose steroids ** Radiation A decompression

*** FECAL INCONTINENCE: # weak to get the bathroom, Diarrhoea, Impacted feces, Rectal carcinoma, spinal cord compression *Rx: ** treat the cause

*** TREMORS: ** Mysolin ** Beta-Blockers ** Benzo: Klonopin ** Neurontin

*** MUSCULAR SPASMS: *Rx: ** Diazepam ** Baclofen ** Physical therapy ** Replace magnesium & calcium