Exam 4 Neuro Trauma: Cerebral Flashcards Preview

Q4 EM Surg > Exam 4 Neuro Trauma: Cerebral > Flashcards

Flashcards in Exam 4 Neuro Trauma: Cerebral Deck (34):
1

Closed Head Injury (CHI): Coup v Countercoup?

Coup = Injury at sight of impact

Countercoup = Injury at site opposite impact

2

ICU monitoring of head injury includes? (8)

IVF
Card monitoring
BIS monitoring (brain activity)
Tube feed
Sedation
Vent
Central line
A-line

3

A-line goes where?

Used for?

Not used for?

U radial a

Monitor BP
Get ABG samples

Meds

4

Central line goes where?

Used for?

U int jugular or subclavian

Monitor venous pressure
Fluids/meds

5

Critical factor of brain fxn is?

Cerebral blood flow (CBF)

6

Cerebral Perfusion Presssure (CPP) is?

MAP - ICP
N ≥ 50

7

ICP normal values: Adult?

Kids?

< 15

< 7
1.5 - 6 infants

8

↑ in ICP leads to?

Arterial pressure displacement ->
CPP ↓ ->
Cerebral ischemia

9

If ICP = MAP, what happens?

arterial blood can't enter skull

10

Uncal Herniation is?

Uncus (inner temporal lobe) pushed into mid-brainstem -> CN III compression

Most C type of herniation
U from trauma

Ipsilat eye turned down/out, pupil dilated
Visual defects

11

Coma scale for Closed Head Injury:

Mild?

Mod?

Severe?

Brain death?

Mild > 13

Mod 9 - 13

Severe < 9

Brain death = 3

12

Decorticate posturing?

Hands to body core,
Plantar flex
Internal rotation of legs

13

Decerebrate posturing?

(Damage to corticospinal tract @ pons/medulla)

Legs same
Arms extended, pronated
Wrists flexed

14

Exam findings for Basilar Skull Fxr? (4)

Racoon eyes
Battle sign
Hemotympanum
CSF rhinorr/otorrhea

15

Extremity neuro exam rating:

1/5?

2/5?

3/5?

4/5?

5/5?

1/5 = Flicker

2/5 = mvmt w/ no gravity

3/5 = mvmt against gravity

4/5 = weakness

5/5 = complete

16

Reflex neuro exams? (4)

DTR
Clonus
Babinski
Hoffman (flick fingernail, other fingers flex)

17

IntraAxial Cerebral Hemorr includes?

Intracerebral hemotoma
Diffuse Axonal Injury

18

ExtraAxial Cerebral Hemorr includes? (3)

Subarachnoid hemorr
Subdural hemorr
Epidermal hemorr

19

Diffuse Axonal Injury is?

IntraAxial Cerebral Hemorr
2nd most C
U multiple lesions

20

SDH presentation:

Age?

Co-morb?

Atrophy?

Caused by?

Which vessels?

CT findings?

Onset?

Tx?

Age = Elderly

Co-morb = Coagulopathy

Brain atrophy

Cause = Traumatic or spontaneous (U falls)

In Bridging veins

CT = Crescent along the brain

Acute: sxs w/i 24 hrs
Subacute: sxs 24hrs to 2wks post
Chronic: sxs > 2wks

Craniotomy
Burr hole
Observation

21

EDH presentation:

Age?

Co-morb?

Atrophy?

Caused by?

Which vessels?

CT findings?

Onset?

Tx?

Age = young adult

Co-morb = U none

Atrophy = little or no brain atrophy

Caused by = trauma only

Which vessels = U Middle meningeal aa in temporal-parietal area

CT findings = Lenticular (lens) shape attached to dura

Onset = Acute onset, lucid intervals

Tx = Craniotomy, observation, NO burr hole

22

Intracranial HTN:

O2 goal?

BP goal?

Fluids?

Glucose?

Elevate head?

PaO2 > 60 or O2 sat > 90%

SBP/MAP > 90

NS + KCl
Avoid LRs and hypotonics

Avoid hypergly (80-180)

30-45° (helps venous outflow, lowers carotid pressure)

23

Intracranial HTN: Coag mgmt

INR?

Platelets?

Hgb?

Central venous pressure?

Reverse coagulopathy w/?

Sedation?

Correct INR

Platelets > 75

Hg > 9

CVP 5-7

Coumadin, Plavix

Heavy sedation w/ Fentanyl lowers ICP

24

Mannitol is used for what?

IC HTN
Osmotic effect draws edema from brain tissue

25

Most potent means of causing vasodilation in IC HTN?

↓ PaCO2 to 30-35 w/ hyperventilation

26

Guillain Barre etiology? (7)

Most C demyelination neuropathy
Viral URI
Immunization
Surgery
C. jejuni
CMV
Mycoplasma

27

Guillain Barre presentation? (7)

Sxs onset days-wks post infection
Symmetrical Ascending paralysis (legs and up)
Progressive mm weakness
Areflexia
U CN involvement
P paresthesia and loss of proprioception
ELEVATED CSF protein w/o pleocytosis

28

Guillain Barre tx? (4)

IVIG x 5 days
Plasmapharesis x 5 exchanges
NO steroids
U full recovery @ 1 yr

29

Meningitis caused by: ≤ 3 mo? (3)

Strep B
E coli
Listeria

30

Meningitis caused by: kids? (3)

Neisseria
Strep pneumo
H flu B

31

Meningitis caused by: adults? (3)

Neisseria
Strep pneumo

32

Meningitis presentation? (4)

N/V
HA, Photophobia, Confusion
Stiff neck
+ Brudzinski/Kernig

33

Meningitis diagnostics?

Lumbar puncture for:
Cx/count
Protein
Glucose

34

Meningitis long term effects? (3)

Deaf
Encephalopathy
Seizures