Flashcards in Exam 4 Neuro Trauma: Cerebral Deck (34):
Closed Head Injury (CHI): Coup v Countercoup?
Coup = Injury at sight of impact
Countercoup = Injury at site opposite impact
ICU monitoring of head injury includes? (8)
BIS monitoring (brain activity)
A-line goes where?
Not used for?
U radial a
Get ABG samples
Central line goes where?
U int jugular or subclavian
Monitor venous pressure
Critical factor of brain fxn is?
Cerebral blood flow (CBF)
Cerebral Perfusion Presssure (CPP) is?
MAP - ICP
N ≥ 50
ICP normal values: Adult?
1.5 - 6 infants
↑ in ICP leads to?
Arterial pressure displacement ->
CPP ↓ ->
If ICP = MAP, what happens?
arterial blood can't enter skull
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
Coma scale for Closed Head Injury:
Mild > 13
Mod 9 - 13
Severe < 9
Brain death = 3
Hands to body core,
Internal rotation of legs
(Damage to corticospinal tract @ pons/medulla)
Arms extended, pronated
Exam findings for Basilar Skull Fxr? (4)
Extremity neuro exam rating:
1/5 = Flicker
2/5 = mvmt w/ no gravity
3/5 = mvmt against gravity
4/5 = weakness
5/5 = complete
Reflex neuro exams? (4)
Hoffman (flick fingernail, other fingers flex)
IntraAxial Cerebral Hemorr includes?
Diffuse Axonal Injury
ExtraAxial Cerebral Hemorr includes? (3)
Diffuse Axonal Injury is?
IntraAxial Cerebral Hemorr
2nd most C
U multiple lesions
Age = Elderly
Co-morb = Coagulopathy
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
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
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)
Intracranial HTN: Coag mgmt
Central venous pressure?
Reverse coagulopathy w/?
Platelets > 75
Hg > 9
Heavy sedation w/ Fentanyl lowers ICP
Mannitol is used for what?
Osmotic effect draws edema from brain tissue
Most potent means of causing vasodilation in IC HTN?
↓ PaCO2 to 30-35 w/ hyperventilation
Guillain Barre etiology? (7)
Most C demyelination neuropathy
Guillain Barre presentation? (7)
Sxs onset days-wks post infection
Symmetrical Ascending paralysis (legs and up)
Progressive mm weakness
U CN involvement
P paresthesia and loss of proprioception
ELEVATED CSF protein w/o pleocytosis
Guillain Barre tx? (4)
IVIG x 5 days
Plasmapharesis x 5 exchanges
U full recovery @ 1 yr
Meningitis caused by: ≤ 3 mo? (3)
Meningitis caused by: kids? (3)
H flu B
Meningitis caused by: adults? (3)
Meningitis presentation? (4)
HA, Photophobia, Confusion
Lumbar puncture for: