Neurologic Emergencies Flashcards
What is the Monro-Kellie Doctrine?
80% Brain
10% Blood
10% CSF
Intracranial Pressure
Normal ICP: 5-15 mmHg
Herniation
Risk if ICP >20 longer than 5 mins
MAP Equation
Diastolic + 1/3 (Systolic - Diastolic )
Cerebral Perfusion Pressure
CPP = MAP - ICP
Optic Ultrasound
Monitors ICP by measuring optic nerve diameter
SjVO2
Fiber optic catheters placed into IJ to measure cerebral oxygen supply, perfusion, and consumption.
PbtiO2
brain tissue oxygenation monitoring, electrode placed on at-risk tissue
Intracerebral Microdialysis
Pulls minute amount of blood out to measure brain neurochemistry
Penumbra
Area surrounding the dead tissue is hypoxic, irritated, and is salvageable
Ischemic Stroke: BP Management
Systolic: 140-160
Diastolic: 70-90
<180/105 before, during and 24hrs after tPA
tPA
Tissue Plasminogen Activator
-0.9 mg/kg max 90mg
-10% over 1 minute, 90% over 60 minute transfusion
TNK
Tenecteplase
- Cheaper than tPA
- More favorable
- Given in a single bolus
Subarachnoid Hemorrhage
SAH
“Worst headache of life”
“Thunderclap”
Starfish sign on CT
AEIOU TIPS
Acidosis
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psychosis
Seizures
Glasgow Coma Scale
Eye opening (1-4)
Verbal responsiveness (1-5)
Motor function (1-6)
Delirium
“Acute brain failure”
GCS Eye Opening
4-Spontaneous
3-To sound
2- To pressure
1-None
GCS Speech
5-Oriented
4-Confused
3-Words
2-Sounds
1-None