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Flashcards in Nervous System Deck (28):
1

Increasing ICP: EARLY S/Sx

1- MS change (combative, irritable, disoriented…)
2- Severe headache (crushing)
3- Persistent vomiting (lots of things provoke 1 puke... look for persistent)

2

Increasing ICP: LATE S/Sx

1- V/P/U on AVPU
2- Seizures
3- Posturing
4- Dilated pupil
5- Major change in vital signs

3

Increasing ICP: Rx

BLS: Airway control, Ventilation, core temp, hydration during Evac (Evac = priority)

4

Head Trauma = most common way of getting _____

ICP = most commonly gotten from _________

5

Head Trauma: S/Sx of No Brain Injury (2)

1- No LOC; no change in AVPU
2- No amnesia

No A' for increasing ICP
(Could look bad; soft tissue wound, laceration, contusion)

6

Head Trauma: S/Sx of TBI (2)

1- Any change in AVPU
2- Any degree of amnesia

(Even just being dazed and confused, or "punch drunk")

7

Head Trauma: High Risk factors for increasing ICP (6)

1- Persistent disorientation (brain not returning to normal shortly after event)
2- Cannot retain new memory (or amnesia for a significant time period)
3- History of recent TBI (concussion)
4- Skull fracture
5- High velocity or high mass impact
6- S/Sx of increasing ICP (change in AVPU...)

8

Spinal Cord Injury: Cervical Vertebrae (# and likelihood of injury?)

7 vertebrae; most likely to be injured

9

Spinal Cord Injury: Thoracic Vertebrae (# and likelihood of injury?)

12 vertebrae; stronger portion of 3 major spinal regions

10

Spinal Cord Injury: Lumbar Vertebrae (# and likelihood of injury?)

5 vertebrae; 2nd most likely to be injured

11

Spinal Cord Injury: Sacrum + Coccyx

No spinal cord in these parts of spine

12

Spinal Cord Injury: MOI (4)

1- Trauma
2- Oxygen
3- Pressure
4- Electricity

13

Spine Injury Assessment: Step 1... what to consider before you start (5)

1- Reliable Pt
2- No distracting injuries
3- Not intoxicated
4- Wants to cooperate
5- Can cooperate

(See also CCC-SANDINA)

14

CCC-SANDINA

Must have before can clear a spine:
C: Calm
C: Cooperative
C: Communication
S: Sober (intoxicated or meds)
A: Alert
N: No...
D: Distracting...
I: Injury
N: No...
A: ASR

15

Spine Injury Assessment (wilderness protocol), Spine is clear when met these 3 things...

1- Clear MS (reliable)... see also CCC- SANDINA
2- Clear of new S/Sx (new pain, distal numbness or weakness?)
3- Clear physical exam

(Do not rush to clear spine; last thing you do, unless good reason to earlier; Assessment, not a pass/fail test... motivation should be to find the injury, not "clear the spine")

16

Spinal Injury Assessment: Physical Exam

1- No tenderness to firm spine palpation
2- Intact distal motor/sensory exam:

Upper extremities: finger abduction, wrist extension; no tingling, numbness; sharp/dull pain discrimination (back of hand and wrist).

Lower extremities: plantar and dorsi-flexion of feet or toes; no tingling, numbness; sharp/dull pain discrimination (top of foot or lateral aspect of lower leg).

17

Spinal Injury: High Risk Problems (4)

1- Persistent neurological deficit
2- Palpable deformity
3- Other critical system problems
4- Severe pain

18

AVPU

A: Awake; further define MS (oriented, disoriented, confused, combative, etc... "A and O x 4": person, place, time, event)
V: Responds to verbal stimulus
P: Responds to pain stimulus
U: Unresponsive

19

TBI: Field Rx (7)

1- Early Evac = ideal, even if ICP is low probability it has high consequences (BLS w/ airway, ventilation, core temp, hydration)
2- Monitor 24h for increasing ICP
3- Sleep ok, but not alone, wake every hr to ck MS
4- Anticipate vomiting and Airway obstruction
5- Anticipate dehydration (vomiting) + hypothermia
6- Pain meds (APAP preferred, not NSAIDS)* and no MS altering drugs (narcotic, stimulants, alcohol)
7- Avoid another TBI

* see other card for why

20

Pain meds if have TBI

APAP (acetaminophen) = preferred because it doesn't cost platelets (ICP could be due to bleeding)

No NSAIDS

21

"Post Concussive Syndrome"

1- can occur without measurable brain injury
2- develops > 24 h after injury, can last days, Sx can wax/wane for weeks
3- normal MS with: mild/moderate headache, blurred vision or photophobia, disrupted sleep, nausea, loss of appetite, dizziness
4- does not (rarely) indicate elevated/ing ICP
5- symptomatic Rx as needed
6- non-urgent medical follow-up

(Progressive, worsening or appearance of new Sx -> Urgent Evac)

22

Effects on MS: MOI (impaired brain function)...

Sugar
Temperature
Oxygen
Pressure
Electricity
Altitude
Toxins
Salt

23

Seizure: MOI

STOPEATS
Epilepsy

(Often occurs from missed medication dose)

24

Seizure: Rx (4)

1- protect from injury and other rescuers
2- Treat cause
3- Evac for medical follow up
4- PROP, BLS... ALS as needed

(After Pt Will be exhausted, dazed, confused for a long while sometimes)

25

Seizures: High Risk (5)

1- Result of trauma or environmental illness
2- Persistent neurological deficit
3- New onset seizure (never had before)
4- Recurrent seizure
5- Pt getting worse

(Real worry is not seizure itself but what may have caused it)

26

Increasing ICP: Causes

Brain swelling from bleeding or edema; causes include:
TBI
HACE
Hypoxia
Stroke
Hyperthermia

27

Increasing ICP: 5 Mechanisms

(P on STOPEATS)
1- Trauma (most common)
2- Stroke
3- Hypoxia
4- Altitude
5- Hyperthermia

28

HACE: what is it?

High-altitude cerebral edema:
brain swells with fluid because of the physiological effects of traveling to a high altitude.