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CP3 Medicine > Neuro - Neurological emergencies > Flashcards

Neuro - Neurological emergencies Flashcards

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1
Q

Def status epilepticus

A

Life-threatening neuro condition - 5 or more mins of either continuous seizure activity or seizure activity w/o gaining consciousness

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2
Q

RF status epilepticus (4)

A

Non-adherence to anticonvulsant Dx
Chronic alcoholism
Refractory epilepsy
Toxic/metabolic causes

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3
Q

1st step Mx status epilepticus

A 
A-E
High flow O2 
BM
Temp 
Establish Hx /collateral Hx
IV access
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4
Q

2nd step Mx status epilepticus

A

After 5 mins

Buccal midazolam or IV lorazepam

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5
Q

3rd step Mx status epilepticus

A

After another 10 mins - give 2nd dose of benzos

Make sure anaesthatist has been called

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6
Q

4th step Mx status epilepticus

A

IV phenytoin 18mg/kg

Max = 50mg /min

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7
Q

Acute causes of NM ventilatory compromise

A

GBS

Myasthenic crisis

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8
Q

Chronic causes of NM ventilatory compromise

A

MND

Myotonic dystrophy

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9
Q

Sx NM ventilatory compromise (7)

A 
Resp failure 
Weak cough 
Paradoxical diaphragm movement 
Breathless when flat 
Use of accessory mm 
Incr RR
Can't clear secretions
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10
Q

Bedside Ix NM ventilatory compromise (2)

A

VITAL CAPACITY!!!

ABG

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11
Q

ABG results acute NM ventilatory compromise

A

pH <7.35
PO2 <8
PCO2 >6
Bicarb = low/norm

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12
Q

ABG results chronic NM ventilatory compromise

A

pH norm
PCO2 >6
Bicarb >26mmol/L

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13
Q

What is a primary traumatic brain injury

A

Immediate result of trauma

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14
Q

What is a secondary traumatic brain injury

A

From complications of the trauma

I.e. hypoxia, ischaemia, haematoma

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15
Q

Def concussion

A

Transient LOC but no persistent neuro signs

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16
Q

Features of concussion

A

Temporary confusion/amnesia

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17
Q

PS diffuse axonal injury

A

Decr [ ]/memory

Personality change

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18
Q

Mx diffuse axonal injury

A

Supportive

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19
Q

2 types of damage in focal brain injury

A

Coup + counter-coup

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20
Q

What is post-concussion syndrome

A

Dizziness
Headache
Decr [ ]/memory

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21
Q

Mx post-concussion syndrome

A

Physio + OT helps

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22
Q

Assessment of someone with suspected head injury

A 
C-Spine 
A-E
Record GCS
Hx if conscious 
Check for signs incr ICP
Imaging - CT/C spineXR
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23
Q

Signs of declining neurological status after head injury (5)

A 
Decr in GCS
Pupil changes 
Development of focal signs 
Change in resp rate
Cushings sign - decr pulse but incr BP
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24
Q

Why does Cushings signs occur?

A

Pressure on medulla oblongata

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25
Bilateral pupil changes after head injury signify
Pre-terminal
26
Who must have a CT head within an hour? (7)
``` If GCS <13 on admission or <15 at 2hrs Focal neuro deficit Incr ICP Suspected skull # Post-trauma seizure Vom >1 ```
27
Who must have CT head within 8hrs (4)
``` Anti-coag'd LOC + : +65 y/o Dangerous mechanism Retrograde amnesia >30 mins before injury ```
28
Which bone is involved in a posterior fossa fracture?
Temporal bone
29
What is Battle's sign
Bruising over mastoid
30
PS posterior fossa fracture
``` Battles sign CSF otorrhoea Bleeding in ear Conductive deafness CN palsy 5-7 ```
31
Mx posterior fossa fracture
Rx to neurosurgery
32
What bones are involved in an anterior fossa fracture
Occipital Sphenoid Ethmoid
33
PS anterior fossa fracture
Raccoon eyes CSF rhinorrhoea Bleeding from nose
34
Mx anterior fossa #
Rx to neurosurgery
35
Complications fossa # (3)
Intracranial infection Facial nn palsy Carotid injury
36
Mx depression skull #
Surgical exploration within 12hrs
37
GCS - E4
Open eyes spontaneously
38
GCS - E3
Open eyes to speech
39
GCS - E2
Open eyes to pain
40
GCS - E1
No response
41
GCS - V5
Oriented to time, person + place
42
GCS - V4
Confused
43
GCS - V3
Inapprop words
44
GCS V2
Incomprehensible sounds
45
GCS V1
No response
46
GCS M6
Obeys command
47
GCS M5
Moves to localised pain
48
GCS M4
Flex to withdraw from pain
49
GCS M3
Abnormal flexion
50
GCS M2
Abnormal extension
51
GCS M1
No response
52
DDx - unconscious pt
``` Vascular (stroke,shock,haematoma, SAH) Infective - sepsis, meningitis, encephalitis, abscess Trauma Autoimmune - BS demyelination Metabolic - gllucose, Ca, Na Neoplasm ```
53
What does Cheyne stokes breathing indicated
Coning
54
What does Kussmal resp indicate
Acidosis or Uraemia
55
Cause of extradural haemorrhage
Blow to side of head
56
Which artery is classically affected in extradural haemorrhage
MMA
57
PS extradural haemorrhage (4)
brief LOC Lucid phase Progressive hemiparesis + stupor Coning - dilated pupil
58
If unTx, how can extra-dural haemorrhage progress
To hemiplegia + resp arrest
59
Ix findings extradural haemorrhage
CT - lemon shape
60
Mx extradural haemorrhage
Urgent Rx neurosurgery | Burr hole
61
What is hydrocephalus
Excessive CSF within cranium
62
What are the 2 types of hydrocephalus
Non-communicating | Communicating
63
What is non-communicating hydrocephalus due to?
Blockage of CSF pathway from ventricles to SAS
64
What is communicating hydrocephalus due to?
impairment of CSF reabsorption in arachnoid villi | Infection/SAH
65
Who are the 3 pt groups at risk of suffering from hydrocephalus?
Congen malformations - stensis aqueduct of sylvius tumour (post fossa/BS) Post brain assault (SAH/head injury/meningitis)
66
PS of acute hydrocephalus
``` Headache Vom Papilloedema Ataxia Bilatereal pyramidal signs ```
67
Ix acute hydrocephalus
CT | MRI if suspect tumour
68
Mx acute hydrocephalus
Acetazolamide +/- furosemide | Surgical shunt
69
What are the 2 types of shunts used in hydrocephalus Mx ?
Ventriculo-arterial | Ventriculo-peritoneal
70
What is normal pressure hydrocephalus?
syndrome of enlarged lat ventricles which usually presents in elderly t
71
What is the clinical triad seen in normal pressure hydrocephalus
WACKY, WEEING, WOBBLY Dementia Urinary incontinence Apraxic gait
72
What is an apraxic gait
Slow Broad based Shuffling

CP3 Medicine (29 decks)

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