Flashcards in Acute Neuro Patient - Haemorrhage Deck (17):
What can raise the ICP in an individual? What is the Monro-Kellie doctrine?
Anything that increases volume of:
* known as the MONRO-KELLIE doctrine
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!
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!
- 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)
List all the types of cerebral haemorrhage
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)
Medical management of EDH and SDH
bone flap taken out
- SDH tends to be more contained so bone flap removed and clot taken out
What are CI's and P's for EDH/SDH?
Make sure helmet is worn out of bed
- 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
Medical management of SAH
- immediate bed rest
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
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
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!
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?
Medical management of cerebral tumours
- type (i.e speed of growth)
- effects on functions
- CHEMO/RADIATION might be used to shrink the tumor - then SURGERY
- MEDS for Sx control
What is hydrocephalus? What causes it?
Increase in CSF in the ventricles (enlarged on MRI) - therefore increase in ICP (Monro Kellie doctrine)
- - tumor
- aqueduct stenosis
- congenital blockage (spina bifida)
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