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Flashcards in Neuro Deck (145):
1

Cranial Nerves - 12

I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Acoustic IX. Glossopharyngeal X. Vagus XI. Spinal Accessory XII. Hypoglossal

2

Hypoglossal CN

XII - tongue movement - motor ; stick out tongue; weakness ? - tongue goes to stronger side

3

Spinal accessory

sternocleidomastoid and trapezius muscle control - neck strength and shoulder shrug (against resistance) - motor ;

4

Glossopharyngeal + Vagus

gag, swallow, and cough reflexes; voice quality; vagal parasympathetic response - both

5

Acoustic

hearing and balance - sensory ; test by whispering

6

Facial CN

VII - anterior taste buds + facial muscles - both

7

Trigeminal

motor function of temporal and jaw muscles ; sensory on face - both

8

Oculomotor + Tronchlear + Abducens

ocular muscle movement - motor - PEARLA

9

Optic

visual acuity - sensory ; Snellen chart

10

Olfactory

smell - sensory

11

CNS consists of ...

1. Brain - cerebrum, cerebellum, brain stem 2. Spinal cord

12

PNS consists of ...

1. 31 pairs of spinal nerves 2. 12 pairs of cranial 3. Autonomic NS

13

Autonomic NS consists of ...

1. Sympathetic NS - speeds ; anticholinergic 2. Parasympathetic NS - slows; cholinergic - responsible for involuntary movement of smooth muscles present in GI tract, urinary tract and lungs

14

Flexed arms, extended legs, plantar flexion, internal rotation of limbs and feet - "toward the cord" - affecting cortical area of brain

Decorticate posturing

15

Extended arms and legs, plantar flexion, external rotations of limbs and feet; dysfunction in the brainstem area 

Decerebrate posturing

16

No motor function or response

Flaccid

17

White fiber tracts that connect the neurons in the brain and spinal cord ; only one ... attached to each neuron ( can extend down the entire spinal cord)

Axon

18

A white, lipid covering many axons; white matter; ... axons have gaps called nodes of Ranvier - play a major role in impulse conduction

Myelin sheath

19

Autoimmune disease; characterized by inflammatory response that results in diffuse random or patchy areas of plaque in the white matter of the CNS - myelin sheath is damaged (demyelinated) - impulses still transmitted but not as effective; over time can become completely blocked.

Multiple Sclerosis - pathophysiology

20

MS: Classification

1. Benign MS - 1-2 attacks - complete recovery 2. Relapsing Remitting MS - most common - relapses with partial or full recovery - no progression between attacks 3. Secondary Progressive MS - follows RRMS in 50 % - progressive disability 4. Primary Progressive MS - steady slow progression ; uncommon; little tx available 5. Progressive Relapsing MS - progressive + flare ups ; rare

21

MS: 1.axons of the nerve remains intact - ... 2. both myelin and axon are destroyed - ...

1. Pt. will regain all function and sensation during remission 2. Permanent loss of motor and sensory function

22

MS: Etiology

1. Autoimmune - following stress 2. Viral 3. Familial tendency 4. Cold climates 5. Females - 15-50 (20-40)

23

MS: S/s

1. Visual disturbances 2. Internuclear opthalmoplegia - abducting eye ( to the side) - nystagmus 3. Sensory sensations - tingling, numbness... 4. Unusual clumsiness, extremity weakness, leg dragging ... 5. All symptoms intensified by hyperthermia 6. Lhermitte's sign - flex neck - electrical sensation - down the back - into legs

24

MS: Visual problems

1. Nystagmus - involuntary rapid eye movement 2. Diplopia - double vision 3. Blurry vision 4. Scotoma - patchy blindness

25

MS: TX - medications

1. Corticosteroids - exacerbation 2. Immunomodulators - for life to slow or stop 3. immunosuppresant agent

26

Immunosuppresant agent; tx of MS; anticancer; lifetime limit of 8-12 doses - or cardiac damage occurs; shuts down part of immune system causing MS.

Mitoxantrone hydrochloride ( Novantrone)

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1. Avonex 2. Betaseron 3. Copaxone

Immunomodulators - tx of relapsing-remitting MS ; remission therapy 

1. drug of choice; IM/weekly

2. sub-q daily or 3x's weekly SE: flue like S/s - decrease in 3 mo; nightmares

3. acts like decoy; subcut/daily ; SE: skin decubiti; chest pain (like MI)

28

Bethanechol (Urecholine)

Cholinergic agent - parasympathomimetic ; MS: treat flaccid bladder; neurologic bladder (incontinence)

29

Oxybutynin Chloride (Ditropan)

Anticholinergic (cholinergic blocker; parasympathetic depressant) - tx spastic bladder - MS

30

1. Baclofen 2. Flexeril 3. Robaxin 4. Zanaflex

CNS depressant; sympathetic depressant; treat muscle spasticity + spasms

31

Dandrolene (Dantrium)

CNS direct acting (peripheral) - treat muscle spasticity

32

Decubiti

pressure sore or bed sore - A pressure-induced ulceration of the skin occurring in persons confined to bed for long periods of time

33

1. Decadrone (Dexamethasone) 2. Methylprednisolone (Solu-Medrol)

Corticosteroids

34

Reticular activating system

special cells throughout the brainstem - control awareness + alertness ; the reticular formation are has many connections with the cerebrum, the rest of the brainstem and the cerebellum

35

Caloric test

ice/warm water is forced into ear canal - eyes rotate to opposite/same side of head (Nystagmus) ; performed to evaluate the vestibular (inner ear) portion of auditory nerve ; helps to determine brain death.

36

Obtunded

awakes only momentarily; confused

37

Persistent Vegetative State

awake, but unaware of surroundings

38

Locked-in syndrome

due to brain stem damage - awake and alert , but unable to move or respond, except by blinking eyes; death due to respiratory distress

39

Light vs deep coma

unresponsive, except to painful stimuli vs unresponsive

40

Brain stem consists of

Midbrain Pons Medulla

41

connects brain stem and cerebrum

Midbrain

42

bridges the two halves of the cerebellum to the medulla and cerebrum

Pons

43

site of reflex centers for many vital functions, i.e.: • respiratory • cardiac • vasomotor

Medulla

44

The NS is composed of two types of cells

1. Neurons 2. Neuroglial cells - support, nourishment, and protection for neurons

45

Neuroglial cells - types

1. Astrocytes 2. Oligodendroglia 3. Ependymal cells 4. Microglia

46

A tumor that arises from cells that comprise the supporting tissue of the nervous system; Malignant !!!

Gliomas

47

Pituitary adenoma types : Benign !!!

1. Prolacting secreting - Galacterhea (milk production)

 2. ACTH secreting - Cushings syndrome (increase in corticosteroids) 

3. Growth hormone secreting

48

controls the hormones released by the adrenal gland that support blood pressure, metabolism, and the body's response to stress

Adrenocorticotrophic hormone (ACTH)

49

Transphenoidal micro surgical approach

through the nasal passage, going along the septum -  then through the sphenoid sinus cavity located deep above the back of the throat to the pituitary gland immediately behind it; tx of pituitary adenoma; Mustache dressing - nose is packed - prevent sneezing ( increase ICP).

50

Tumor of the 8th CN, can grow quite large; always benign; S/s - vertigo + ringing in the ears (tinnitus) + staggering gait 

Acoustic neuroma

51

Tumor - mass of blood vessels usually congenital ; risk for hemorrhagic stroke; benign

Angioma

52

Benign, highly vascular tumors which originate in the meningeal layer

Meningioma

53

Infratentorial tumor - craniotomy - positioning ; + cervical fx

Bed flat with small pillow for pt.

54

Hydrocephalus - increased CSF related to obstraction of the flow of CSF or displacement of the lateral ventricles by the expending lesions - increased ICP - S/s and TX

S/s : 1. gait disturbance 2. incontinence 3. confusion

TX: Ventriculoperitoneal or ventricular jugular shunt 

55

Halo sign

red stain of blood surrounded with yellow "halo" stain, which is CSF. Need to test with a glucose strip to ensure this is what stain is showing - then call doctor

56

S/s of increased ICP

1. Headache 2. Deteriorating LOC 3. Restlessness 4. Irritability 5. Dilated or pinpoint pupils that are slow to react or nonreactive to light

57

DI - diabetes insipidus

failure of posterior pituitary gland to release ADH - failure of renal tubules to reabsorb water - urine output is increased (polyuria) - dehydration ( polydipsia) , hypovolemic shock ; Hypernatremia

58

Vasopressin (Pitressin) - IV

 Desmopressin acetate (DDAVP) - IV or nasal spray 

antidiuretic hormone; tx of diabetes insipidus

59

SIADH

syndrome of inappropriate ADH - posterior pituitary gland releases too much ADH - water retention - loss of thirst, weight gain, muscle weakness, decreased LOC; Hyponatremia (dilutional) 

60

1. Epidural - between skull and dura - least invasive - least accurate 

2. Subarachnoid screw - CSF flows - small sample - cannot drain CSF

3. Intraventricular - most invasive - most accurate (transducer) - can drain CSF if ICP is elevated 

ICP monitoring devices

61

1. Brudzinski's sign 2. Kernig's sign

1. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. 2. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

62

The spinal cord is composed of 31 pairs of spinal nerves:

• 8 cervical • 12 thoracic • 5 lumbar • 5 sacral • 1 coccygeal

63

Dorsal root

Posterior. Contains the sensory portion; afferent in nature (from the body inward to the cord). Part of the body picks up a sensory stimulus which travels ↑ cord to the brain.

64

Ventral root

Anterior. Is efferent in nature. Impulses travel outward from the brain ↓ cord → body. Contains the motor portion.

65

UMN lesions 

1. Loss of voluntary movements;

2. Tense muscles - increased tone

3. Spastic muscles 

4. Hyperactive reflexes 

66

LMN lesions 

1. Loss of voluntary movements 

2. Decreased muscle tone 

3. Muscle atrophy 

4. Absent or dimished reflexes 

67

Autoimmune disease; loss of motor neurons in the anterior (ventral) horns of the spinal cord + motor nuclei of the lower brain stem - muscle atrophy - both upper and lower motor neurons ; death due to respiratory failure; bowel and bladder are not affected - pt remains continent

Amyotropic Lateral Sclerosis (ALS) - Lou Gehrig's Disease

68

Riluzole (Rilutek)

tx of ALS - slows progression of the disease

69

Brain injury; Jarring of the brain-possibly microscopic hemorrhages; closed injury; mild; up to 5 min ( neurological s/s) to 48 hours (headache + N/V); tx: unconscious 5 min - hospital for observation.

Concussion

70

Brain injury; brain is bruised; loss of consciousness > 24 hrs; 60 % behavioral changes; may recover completely.

Contusion

71

Skull fractures types

1. Open - depressed ( corrective sx) & non-depressed; basilar 2. Closed - coup/ contre coup

72

Open skull fracture - Basilar

base of the skull; CSF leakage; motorcycle accidents; swelling may affect brain stem; Battles sign

73

Battles sign

a palpable bogginess of the area behind the ear that may indicate a fracture of a bone of the lower skull; basilar skull fracture

74

Intracranial hemorrhages

1. Epidural 2. Subdural 3. Subarachnoid - due to blunt trauma, aneurysm 4. Intracerebral

75

Bleeding between the inner skull and the dura; compression of surrounding tissue; due to head trauma; EMERGENCY- bleeding from meningeal artery; loss consciousness - lucid - changes in MS - coma - death; tx: burr hole opening to evacuate blood + repair the artery

Epidural hemorrhage

76

Bleeding between dural membrane and arachnoid membrane; venous in origin - s/s develop more slowly; 48 hrs-2 weeks; tx: surgical burr hole;

Subdural hemorrhage

77

Bleeding withing the brain tissue; due to head injury, hypertension, diseases that reduce platelets (ITP, leukemia); nothing can be done; < 5-10 ml - may be reabsorbed without consequences

Intracerebral bleed

78

The wall of a cerebral artery or vein weakens, dilates and forms a sac - ruptured - subarachnoid bleed ; common - Berry aneurysm ( Circle of Willis); - after rupture - cerebral vasospasm + increase in ICP; dx: cerebral angiography

Cerebral aneurysm

79

Osmotic diuretic - pulling fluid from brain tissue into vasculature ; used to tx increased ICP ; most effective given IV boluses ( filter needle) ; + Lasix ( to help to pee it out) ; Monitor: I&O, serum electrolytes + serum osmolarity; Assess increase in urinary output and decrease in ICP 

Mannitol

80

An infection by bacteria that have origin in another part of body (sinus, ear or teeth); tx: antibiotics; dx: CSF positive for bacteria (strep or staph) ; CT - abnormal tissue density; EEG: abnormal.

Brain abscess

81

An inflammation of the brain tissue with no purulent exudate; caused by mosquitoes (west nile); ticks; vaccines; Tx; supportive; antiviral meds; dx: WBC elevated (lymphocytes)

Encephalitis

82

An acute infection of the meninges - arachnoid and pia mater; types: bacterial, viral ( after chickenpox, mumps) and fungul (AIDS pts)

Meningitis

83

Most dangerous, contagious and deadly type of meningitis ???

Meningococcal ( Neisseria) - spreads by secretions; often presents with rash and petechiae - often kills within hours of onset

84

1. Ergotamine + Caffeine (Cafergot) 2. Ergotamine tartate (Ergostat) 3. Dihydroergotamine mesylate (Migranal) 4. Methysergite maleate (Sansert)

Ergotamines - tx migraines - activating serotonin receptors - vasoconstriction - abortive therapy

85

Triptans

Abortive therapy - migraines - activating serotonin receptors - vasoconstriction ; SE: actual or suspected cardiovascular diseases - risk for coronary vasospasm ; Use contraception; Don't take with SSRI and St. John's wort (tx of depression) SE: flushing, tingling, hot sensations.

86

Autoimmune response to a viral infection or vaccines; T cells attack and destroy myelin of the PNS (Schwann cells); initial 2 we; plateau 2 we; recovery 2 ye; Complication - loss of respiratory function

Guillain-Barre Syndrome

87

Bell's Palsy

facial paralysis; VII CN - facial ; rapid onset; lasts 3-5 weeks; Inflammation causes pressure on the nerve which is in a snug channel; S/s - like stroke - one side of the face is paralyzed; tx: steroids; pain meds; eye care ( manually close); facial exercise and massage

88

Trigeminal neuralgia

motor function of temporal and jaw muscles ; sensory on face - both ; pain provoked by movement and stimulation : brushing teeth, chewing, washing face; due to inflammation? or pressure on the nerve ? tx: seizures meds: blood levels drawn for therapeutic range.

89

Glascow Coma Scale 

A image thumb
90

Sympathetic NS vs Parasympathetic NS 

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91

Changes in vital signs ( low BP & HR) due to impaired communication between upper and lower motor neurons; - impaired sympathetic NS activity -  massive vasodialation (low BP) - unoposed parasympathetic NS (low HR) - Emergency - low BP - low perfusion to injured cord - no O2 - edema & ischemia increase ; 

Neurogenic shock - complication of spinal cord injuries 

92

Neurogenic shock - TX

1. Volume expanders ( Dextran )

2. Dopamine - to vasoconstrict 

3. Elevate legs , sequentials , abdominal binder 

93

Unconscious pt must never be placed on their ...

backs - danger of aspiration !!!

94

Interventional neurosurgery - repairing aneurysms - coil or glue procedure - Post op care 

1. Keep pt on his back with HOB at or below 30 degrees 

2. Keep affected leg straight (femoral arterial sheath) - 6 hrs after sheath is removed 

3. Pain meds

4. Monitor site for bleeding or hematoma  - 5 Ps

5. Assess neurological status 

6. Urine output 

7. Check BS - if pt is on Decadron (steroid)

8. Coil - heparin post op; aspirin for life 

9. Glue - MAP < 90 - antihypertensives

95

Demyelination of the peripheral nerves ( they regenerate ) - ascending paralysis ( lower limbs before upper) - muscle weakness + paralysis; causes unknown - post viral ? vaccination ?; Pt. can recover fully ( 1 year) or have long standing neurological deficits

Guillain - Barre Syndrome 

96

Plasmaphoresis and Guillain-Barre Syndrome 

removes circulating antibodies thought to be responsible for the disease - plasma is selectively separated from whole blood - blood cells returned to the pt without the plasma - plasma replaces itself or albumin (colloid) is given ; should be done within several days after the onset of the illness 

97

Plasmapheresis - Complications + Nursing Interventions 

A image thumb
98

Disease that affects the trigeminal - V CN; - sensory branch to face and scalp ; Main issue - Pain; TX: Antiseizure meds (Neurontin) - tx nerve pain.

Trigeminal Neuralgia 

99

Acute paralysis of CN VII but may also affect CN V ; motor part - Ptosis ( drooping) - can't close the eye completely - risk for corneal abrasion or dry eye - lybricate patch at night ; sensory part - Pain ; Usually recover within a few weeks 

Bell's Palsy - Facial paralysis 

100

Migranes - Preventive medications - 2 migranes / week 

1. Beta-blockers - Inderal 

2. Tricyclic antidepressants - Elavil & Tofranil 

3. Antiseizure - Depakote, Neurontin 

4. Ergotamines - Migranal 

101

Migranes - Abortive medications 

1. Acetaminophen / NSAIDs; Excedrin ( acetam. + aspirin + caffeine ) 

2. Ergotamines - Cafergot 

3. Triptans - Imitrex 

102

Ergotamines + Triptans - !!! Caution 

Vasoconstrict - use with caution in pts with hx of CAD, angina, PVD

103

Autoimmune disorder causing a decrease in the neurotransmitter acetylcholine at the neuromascular synaptic junction ; mainly affects face and eyes (muscles intervated by the cranial nerves)- drooping, difficulty chewing; dysphasia; dysarthria; weakness; trouble with secretions ; affects skeletal and respiratory muscles as well. 

Myasthenia Gravis 

104

Anticholinesterase medication - cholinesterase (enzyme that breaks down acetylcholine)  inhibitors 

TX of Myasthenia Gravis - Mestinon + Prostigmin  - every 4-6 hrs; PO; 45-60 min before meals 

105

Mestinon + Prostigmin - SE

Cholinesterase inhibbitors - diarrhea, cramping, increased salivation - until body adjust 

106

Myasthenia Gravis - DX

1. Blood test - acetylcholine receptor antibody ( not positive in every pt) 

2. Tensilon test - give drug to increase acetylcholine (short life) - within a minute - improvement in S/s 

COMPLICATION - PNS - bradycardia ( Atropin ) 

107

Myasthenic crisis vs cholinergic crisis 

Meds not on time ; throwing up due to illness or infection vs too much meds 

108

Medications that should be avoided with myasthenia gravis 

1. Morphine 

2. Curare 

3. Quinine (antimalarial)

4. Quinidine + Procainamide -Antiarrhythmic drugs

5. Mycin-type antibiotics 

6. Drugs containing magnesium 

109

MS - DX 

1. MRI - can see plaques - intefere with impulse to the muscle 

2. LP - SCF - immunoglobulins (IgG)

3. Evoked potential studies - auditory, visual 

110

Multiple Sclerosis - exacerbation/ acute phase tx 

1. Steroids - big doses - Solu-Medrol 

2. ACTH ( hormone from pituitary gland - adrenal cortex - increase secretion of corticosteroids ) 

111

Priority nursing diagnosis for patient with spinal cord injuries at C 5 or higher 

1. Ineffective Airway Clearence 

2. Ineffective Breathing Pattern 

3. Impaired Gas Exchange 

Closely monitor the pt for pneumonia, PE, atelectasis - this problems decrease life expectancy of SCI patients  - leading cause of death 

112

Decadron + Solu-Medrol  - use and SE

High doses steroids are given asap after spinal cord injury to reduce edema ; IV; SE: Infection, elevated serum glucose, stress ulcers ; low K.

113

Intervertabral disc herniation and degenerative disk disease - most common regions ? 

Lumbur (5) - legs  + Cervical (7) - shoulders and arms 

114

Intervertebral disk herniation + degenerative disc disease - non-surgical management 

1. NSAIDs 

2. Medrol Dosepak - steroid 

3. Muscle relaxants - Robaxin + Flexeril - may help control severe muscle spasticity (UMN injuries) ; spasms 

SE: severe drowsiness + sedation 

115

Sciatic Pain 

pain, weakness, numbness or tingling in the leg - herniated disk - lumbar region (5)

116

Microdiskectomy 

Involves microscopic surgery directly through 1-inch incision ; endoscope - remove herniated disk - relieve pressure ; 24 hrs - in and out 

117

Removal of part of laminae and facet joints to obtain access to the disk space ; when repeated laminectomies are performed or if the spine is unstable - spinal fusion is performed to stabilize affected area ; chips of bone are removed (from iliac crest) or obtained from donor bone and are grafted between vertebrae for support and to strenghten the back - metal implants (titanium pins, screws, plates or rods) may be used to ensure the fusion of the spine 

Laminectomy 

118

Laminectomy - post op - correct turning - log rolling 

Every 2 hours from side to back and vice versa ; pt turns as a unit while his or her back is kept as strainght as possible 

119

Anterior cervical diskectomy and fusion - cervical corpectomy 

The priority of care is maintaining airway - swelling from surgery can narrow the trachea causing a partial obstruction 

No lifting

No driving until physician permission 

No strenuous activities 

Walk every day 

Wear brace or collar per surgeons prescription 

 

120

S/s of spinal tumor - depends on location (thoracic 12 - most common)

1. Pais due to pressure on the spinal cord nerve roots 

2. Numbness

3. Tingling 

4. Loss of bladder/bowel function 

5. Foot drop 

 

121

Spinal shock 

trauma to cord itself - flaccid paralysis initially - 4 hrs-2 weeks - until pt comes out of this state - can't assess how much function pt will have - all reflexes are gone - no peristalsis - Risk - paralytic ileus (NG tube) ; Foley.

122

Amyotropic Lateral Sclerosis - DX

1. Increased CK 

2. Abnormal EMG - electromyogram  - give shocks to see how muscle responses - fasciculations (twitching) 

3. Dysarthria + Dysphagia 

123

Cushings syndrome 

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124

Dilantin - SE

Antiepileptic - Antiseizure med - Gingival hyperplasia (overgrowth of gum tissue) - Dental care !!!

125

Cushings triad 

classic but late sign of increased ICP 

1. Severe hypertension 

2. Widened pulse pressure 

3. Bradycardia 

126

ICP

keep below 20 

127

Meningitis S/s:

1. Fever

2. Headache 

3. Nuchal rigidity ( neck stiffness) 

4. Increase in WBC 

5. Brudzinskis and Kernigs signs 

128

SIDH - TX

1. Fluid restriction - ( 800 ml/ 24 hrs)

2. If Na very low ( < 125) - 3 % Saline solution - small amount , slowly - monitor closely - Risk for cerebral edema !!!

129

Craniotomy  - 

1. Supratentorial - cerebrum

2. Infratentorial - cerebellum 

130

Brain Tumors - S/s - depends on location 

1. Changes in personality or behavior (frontal lobe)

2. Headache 

3. N+V 

4. Seizures 

5. Visual disturbances (occipital lobe) 

6. Balance and coordination problems ( cerebellum) - ataxia, falls 

131

Antiseizure meds and SE 

1. Dilantin, Tegretol, Klonopin, Neurontin , Depakote, Valium 

SE: drowsiness, lethargy, sleepiness, sedation (until get adjusted ) Do not drive !!!; Blood dyscrasia (CBC) 

132

PO corticosteroids 

give in the morning ; with food (breackfast) 

133

Stereotactic Radiosurgery - advantages 

for deep seated brain tumors : shrink (radiation) - no incision 

1. noninvasive nature 

2. lower risk, cost, morbidity , length of hospital stay , recovery time 

134

Autonomic Dysreflexia  - T6 or higher - pathophysiology 

Noxious stimulus (distended bladder or bowel) - stimulates SNS - vasoconstriction -  pounding headache + severe hypertension (Risk - Stroke) - baroreceptors of carotid sinus + aortic arch stimulate vagus nerve (PNS) - decreased HR + nausea  - dilates skin vessels above level of injury  - flushing, diaphoresis, nasal congestion 

135

Autonomic Dysreflexia - Nursing Management 

1. Head up

2. Call for help 

3. Assess for + remove noxious stimulus ( catheterize, disimpact ) 

4. Monitor BP Q 10-15 min 

5. CCB  (IV) or Nitrates (Nitroglycerin, Procardia) - sublingual 

136

Niphedipine (Procardia)

Nimodipine (Nimotop) 

Verapamil (Calan) 

Calcium Channel Blockers - tx cerebral vasospasm , hypertension 

137

Ruptured aneurysm S/s 

Severe headache , N&V  - die quickly if massive hemorrhage 

138

Aneurysm that is leaking - S/s 

headache , stiff back and legs, intermittent nausea 

 

139

Strokes - FAST

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140

Complications of aneurysm 

1. Vasospasm - 4-10 days after initial bleed - ischemic episode - brain tissue death 

tx: Prevent !!! - control BP - CCB ( Procardia, Verapamil, Nimotop)

2. Re-bleed - bleed that seals itself can re-bleed within 24-48 hrs or 7-10 days later 

141

Cervical injury suspected - how to open airway 

Jaw thrust - fingers behind the mandible - push forward - will bring tongue forward 

142

Tetraplegia, also known as quadriplegia

Complete paralysis of the body from the neck down.

143

Paraplegia

impairment in motor or sensory function of the lower extremities

144

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