Block 3 Neuro Flashcards
(58 cards)
Sx of HTN ICH? Diagnosis?
Patients usually have focal deficits
Headache and vomiting common
Diagnosis confirmed with head CT w/o contrast or MRI
RF for SAH?
Cigarette smoking and hypertension are the largest risk factors
Hallmark Sx of SAH?
Almost always caused by saccular aneurysm
“Worst headache of my life”/thunderclap headache
Sentinel headache 6-20 days prior
What is Cushing’s Reflex? What condition is it found in?
Found in Herniation
Cushing’s Reflex:
Increased pulse pressure (elevated SBP)
Bradycardia
Irregular breathing
Normal CPP and how do you calculate it?
60-70
𝑪𝑷𝑷=𝑴𝑨𝑷−𝑰𝑪𝑷
SBP goal of Hypertensive ICH + Aneurysmal SAH?
HTN ICH <140
Aneurysmal SAH <160
What are the agents used for acute BP reduction?
Hydralazine
Labetalol
Nicardipine
Clevidipine
Pearls of:
Hydralazine
Labetalol
Nicardipine
Clevidipine
Nicardipine = titratable, but large amounts of fluid/hr
Clevidipine = titratable (fastest), but solution is in a lipid emulsion
Hydralazine = unpredictable onset
Labetalol = caution in patients with bradycardia or history of reactive airway disease
If antifibrinolytic therapy is started, how long should you use it for aneurysmal SAH?
Dont go beyond 72hrs, but typically its not recommended to use at all
_________ is a major contributor to death and complications related to aneurysmal SAH
Vasospams
Vasospasms can be detected using ________ or directly with endovascular approaches
Transcranial dopplers
What is the only FDA-approved medication to reduce DCI associated with aSAH?
Nimodipine
Dosing: 60 mg orally or per tube every 4 hours for 21 days
When is VTE prophylaxis started after HTN ICH or Aneurysmal SAH is stable?
After 24 hrs
What are the 2 types of TBI injury?
Focal
Caused by penetrating or closed impact
Evidenced by hematomas and contusions on CT scan
Diffuse
Caused by rapid acceleration/deceleration
No impact required for this type of injury (MRI works better)
What does the Glasgow Coma Scale (GCS) look at?
Eyes
Motor Response
Verbal Response
3-8 = severe
13-15 = minor
Complications of TBI?
Nosocomial Infection
Deep Vein Thrombosis
Post-traumatic seizures (PTS)
Post-traumatic epilepsy (PTE)
SBP goal of TBI?
Age 50-69 → SBP > 100 mmHg
Age 15-49, 70+ → SBP > 110 mmHg
IC Pressure goal of TBI?
<20
Tx if >22
Non pharm Tx for TBI?
Craniectomy
Therapeutic or prophylactic hypothermia (not recommended)
CSF drainage
Ventilation therapies
What rx are used for TBI?
Mannitol (diuretic) careful in AKI pt
Hypertonic saline; anything above 900 osmolarity (3%NaCl) needs to be given in central line
Analgesics, anesthetics, and Sedatives; they dont lower ICP pressure except propofol
Seizure prophylaxis; phenytoin or keppra can be used for EARLY post-traumatic seizure
Dont give steroids
Albuterol Theophylline Pseudoephedrine Midodrine Fludrocortisone
Which ones increase HR/BP?
HR only:
Albuterol
Theophylline
BP only:
Midodrine
Fludrocortisone
Both:
Pseudoephedrine
Albuterol Theophylline Pseudoephedrine Midodrine Fludrocortisone
Which one has a narrow concentration level?
Theophylline
10-20
What kind of diet works well with fludrocortisone to increase BP?
High salt diet
What are the different GSCE stages?
1 - 0 to 30 min (impeding)
2 - 30 to 60 min (established)
3 - >120 min (refractory); continuous after 2-3 Tx
4 - >24 hrs (super refractory)
