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Flashcards in Acute Neuro Patient - Haemorrhage Deck (17):
1

What can raise the ICP in an individual? What is the Monro-Kellie doctrine?

Anything that increases volume of:
- brain
- blood
- CSF

* known as the MONRO-KELLIE doctrine

2

What is normal ICP?
Markedly elevated ICP?
Critically elevated ICP?

Normal = <10 mmHg
Elevated 20mmHg (vomiting/decreased levels of consciousness)
Critical elevation 40mmHg - hernation through FM!

3

Why is it important to monitor for CLINICAL SIGNS of raised ICP? What are these clinical signs?

- important bc ICP may not always be monitored digitally - so you should have a way to tell!

CLINICAL SIGNS:
- headache
- vomiting
- reduced consciousness
- raised BP (bc as ICP goes up more BP needed to perfuse the brain)
- bradycardia (as BP goes up, HR goes down)
- slow and irregular respiration (d/t inadequate blood to brainstem)

4

List all the types of cerebral haemorrhage

ICH
EDH
SDH
SAH

5

Medical management of ICH

- whether or not this is operated on depends on age, extent of bleed, whether the bleed is stopping on its own
(eg. elderly with small bleed - watch+wait; younger with extensive bleed - operate)

6

Medical management of EDH and SDH

bone flap taken out
- SDH tends to be more contained so bone flap removed and clot taken out

7

What are CI's and P's for EDH/SDH?

Make sure helmet is worn out of bed

8

SAH:
- describe what proportion of strokes it forms
- what age?
- what causes SAH?
- what is the prognosis?

- 5% of all strokes
- <60 yrs (so usually younger)
- SAH caused by AVM and cerebral aneurysm
- prognosis - 70% die or dependent

9

Medical management of SAH

- analgesia
- immediate bed rest
- coiling
- clipping

10

What are CIs/Ps for SAH?

- Nimodipine stops the vasospasm caused by SAH. but may also reduce BVs throughout the body
- therefore POSTURAL HYPOTENSION
- dont mobilize if there's vasospam - too much risk of ischemic brain damage

11

Medical management of TBI

1. Control ICP (paralyze/sedate, external ventricular drain, medications, ventilation to control Co2 pressure)
2. Decompression surgery if ICP remains elevated

12

Is craniectomy helpful?

Cooper et al (2011) - craniectomy vs usual care for raised ICP; although craniectomy group had fewer days in ICU, fewer interventions for ICP, and lower ICP - they also has worse neuro scores and more likely to have poorer outcome!

13

CIs/Ps for TBI

- take care of other concurrent injuries (common for TBI patients)
- PTA (amnesia) may affect assessment/treatment
- dysautonomia (pt suddenly goes into very strong/abnormal postures - can hurt themselves) - make sure casts can be taken off quickly - consider soft/bivalved casts?

14

Medical management of cerebral tumours

Depends on:
- size
- location
- type (i.e speed of growth)
- effects on functions

- CHEMO/RADIATION might be used to shrink the tumor - then SURGERY
- MEDS for Sx control

15

What is hydrocephalus? What causes it?

Increase in CSF in the ventricles (enlarged on MRI) - therefore increase in ICP (Monro Kellie doctrine)

CAUSES:
- - tumor
- infection
- aqueduct stenosis
- TBI
- SAH
- congenital blockage (spina bifida)

16

Medical management of hydrocephalus

CHRONIC - drainage via a shunt (ventricular peritoneal or ventricular-atrial shunt)
VP shunt - drained from ventricles into abdomen where the body absorbs it (this is preferred as more accessible)
VA shunt - drained from ventricles to atrium of the heart

ACUTE - EVD*, Lumbar drain

* make sure EVD is always in line withthe ear - otherwise will affect CSF drainage which could be fatal

17

CIs/P for hydrocephalus

NEVER move head without clamping off the EVD!!!!