Exam 3 - Cindy's

Question 1

Concussion

Answer 1

Mild brief loss of neurological function

Question 2

DAI

Answer 2

Prolonged coma caused by coup/countercoup injury

Question 3

Epidural hematoma (EDH)

Answer 3

ARTERIAL bleeding, bleeding between dura and skull; middle meningeal artery rupture, Brief loss of consciousness, followed, by a lucid period and then deep coma

Question 4

Craniotomy Care

Answer 4

Post-Op: neuro checks, monitor for IICP, check airway, pain, nutritional status and any CSF leaks

Question 5

Complications of SAH (subarachnoid hemorrhage)

Answer 5

Vasospasms
Rebleeds
Hydrocephalus

Question 6

C-1 thru C-4 Cervical spine injury

Answer 6

Assess airway, lose diaphragm use, ventilator dependent

Question 7

Major complications of spinal cord injuries

Answer 7

DVT / PE

Question 8

Autonomic dysreflexia

Answer 8

Exaggerated autonomic response t visceral stimulation occurring with injuries above T6.
MEDICAL EMERGENCY

Question 9

TX/Interventions for Autonomic dysreflexia

Answer 9

Elevate HOB, check for bowel impaction, bladder distenstion, and kinks in foley, evaluate skin for pressure areas. Medicate for HTN using HYPERSTAT, Resperpine or Atropine

Question 10

Plasmaphresis

Answer 10

Infection, hypovolemia, clotting abnormalities, hypokalemia, hypocalcemia, hypotension, myasthenic and cholinergic crisis

Question 11

Contusion

Answer 11

Bruising of the Brain

Question 12

Subdural hematoma (SDH)

Answer 12

VENOUS bleeding, between dura and arachnoid layers; see progressive neuro changes over 2-4 weeks

Question 13

SIADH

Answer 13

Complication post head injury, see coma, may have lung crackles decreased urine output

Question 14

Subarachnoid hemorrhage (SAH)

Answer 14

Bleeding into subarachnoid space between pia and achachnoid layers, usually from rupture of Berry aneurysms.

Question 15

Nimotop (nimodipine)

Answer 15

Prevents vasospasms, give for 21 days

Question 16

Spinal shock

Answer 16

May last weeks to months, see flaccid paralysis below the level of lesion, lose temp control, see hypotension

Question 17

Use of steroids in spinal cord injury

Answer 17

Treats secondary injuries, decreases swelling/inflammation of cord

Question 18

S/S of Autonomic Dysreflexia

Answer 18

Severe HTN
HA
Bradycardia
Flushing of the face/neck
pupil dilation

Question 19

Myasthenia Gravis

Answer 19

Affects neuromuscular transmission of voluntary muscles. See excessive weakness and fatigue of voluntary muscles. Any age, more common in women ages 14-35 and men over 40. Tensilon test will confirm diagnosis

Question 20

Guillian-Barre syndrome

Answer 20

Rapidly ASCENDING peripheral and cranial nerve dysfunction, leading to paralysis. Respiratory arrest is most common cause of death. check vital capacity and ABGs every shift in assessing respiratory function.

Question 21

Monroe-Kellie Doctrine

Answer 21

An increase in blood, CSF, or brain tissue is accompanied by a reciprocal change in the volume in one of the others

Question 22

How to estimate cerebral perfusion pressure. What is normal CPP?

Answer 22

CPP = MAP - ICP

Normal CPP is 60-100 mmHg

Question 23

Factors that increase ICP

Answer 23

Valsalva, coughing, sneezing, body positions, neck flexion

Question 24

Cushing’s Triad

Answer 24

Increased systolic pressure with decreased diastolic pressure (widened pulse pressure) and bradycardia

Question 25

ICP Monitoring

Answer 25

Zero and maintain at Foramen of Monroe (corner of eye) never flush if connected to hemodynamic system

Question 26

Pharmacological management of ICP

Answer 26

Mannitol, lasix, steroids, barbituates, and anticonvulsants

Question 27

Assessment of neuro status

Answer 27

Restlessness

Question 28

Basal skull Fracture s/s

Answer 28

Raccoon's eyes, battles sign

Question 29

Kernig's sign

Answer 29

Cannot extend leg when thigh flexed on abdomen (menningeal irritation)

Question 30

Posturing

Answer 30

Decorticate: flexion of arms to center Decerebrate: extension of arms

Question 31

DKA

Answer 31

Glucose 200-800 Positive serum and urine ketones Insulin dependent diabetics (TYPE 1) Acetone smell to breath

Question 32

HHNS / HHNK

Answer 32

``` Glucose 800-2000 No ketones Serum osmolarity high Elderly Higher mortality rate ```

Question 33

DIC

Answer 33

Overstimulation of normal coagulation mechanisms, leading to microvascular thrombi, consumes all coagulation factors which leads to hemorrhage

Question 34

Labs in DIC

Answer 34

Platelets decreased Fibrinogen level decreased PT/PTT prolonged Fibrin degradation products (FDP) increased

Question 35

Shock

Answer 35

hypo perfusion of body tissues

Question 36

Types of shock

Answer 36

Volume (hemorrhage) Pump (cardiac) Vessel (sepsis and anaphylaxis)

Question 37

MAST

Answer 37

Military anti-shock trousers, used to shunt blood from legs to abdomen and vital organs for perfusion

Question 38

Burn rule of 9s

Answer 38

``` head & neck = 9 arm = 9 ea trunk =18 front/ 18 back legs = 18 ea perineum = 1 ```

Question 39

Calculation of fluid resuscitation for burns

Answer 39

``` parkland formula 4mL/kg X %BSA burned = fluids for first 24hrs -1st 8hrs = 1/2 total Amt -2nd 8hrs = 1/4 total Amt -3rd 8hrs = 1/4 total Amt ``` LR is solution of choice

Question 40

Shock stage of burns

Answer 40

Hypovolemic: fluids shift from vascular to interstitial space, see hemoconcentration and edema. Fluids and electrolytes are lost. HYPERKALEMIA, HYPONATREMIA Diuretic phase: fluids shift back to vascular space, see hemodilution and diuresis.

Question 41

Priorities in burn care

Answer 41

-Airway management first, then fluid resuscitation

Question 42

Cause of myoglobinuria

Answer 42

Skeletal muscle breakdown, increased Ca+ in and destroys muscle fibers. urin is dark rusty brown to black

Question 43

Extremity management in burns

Answer 43

If circumferential, monitor pulses and venous return, monitor for numbness and pain. An escharotomy may be necessary.

Question 44

Wound care in burns

Answer 44

``` Cleansing (hubbard tank) debridement Silvadene (painless) Sulfamylon (painful) Silver nitrate (stains black) ```

Question 45

Primary Assessment for Trauma

Answer 45

Airway breathing circulation, control and external hemorrhage, IV, MAST, immobilize potential fractures Disability, Exposure Fahrenheit, Get full set of vitals, History

Question 46

Secondary assessment for trauma

Answer 46

More thorough and complete assessment Intubate, Place on 100% O2, Stabilize fractures Additional labs and x-rays, possible peritoneal lavage or abdominal scan, OR, ICU, ongoing assessments

Question 47

Factors that have contributed to success of organ transplantation

Answer 47

Cyclosporine Surgical techniques Organ and tissue preservation Legal definition of brain death

Question 48

Drugs used to prevent rejection

Answer 48

Cyclosporine, steroids, prograf