Neurocritical Care

Question 1

___ is usually caused from saccular aneurysm

a. hypertensive intracerebral hemorrhage (ICH)
b. subarachnoid hemorrhage

Answer 1

b. subarachnoid hemorrhage

Question 2

Two types of subarachnoid hemorrhage?

Answer 2

hypertensive

aneurysmal

Question 3

The largest two risk factors for aneurysmal SAH?

Answer 3

cigarette smoking

HTN

Question 4

Which type of hypertensive intracranial hemorrhage causes total paralysis?

Answer 4

pontine

pinpoint pupils ocular bobbing

Question 5

Cushing’s reflex is a sign of what?

Answer 5

herniation

increased pulse pressure
bradycardia
irregular breathing

Question 6

Normal mean arterial pressure (MAP)?

Answer 6

70-105mmHg

Question 7

Normal intracranial pressure (ICP)?

Answer 7

7-15mmHg

Question 8

Hypertensive ICH SBP goal is < __ mmHg

Answer 8

140

Question 9

Aneurysmal SAH SBP goal is < ___ mmHg

Answer 9

160

Question 10

Which has more rapid onset, labetalol or hydralazine?

Answer 10

labetalol

5 mins vs 5-15mins

Question 11

Dose stacking can occur with which acute BP reduction drug?

Answer 11

hydralazine

Question 12

4 drugs for acute BP reduction?

Answer 12

hydralazine
labetalol
nicardipine
clevidipine

Question 13

For pts on anticoagulants who develop any type of intracranial hemorrhage (ICH), when should anticoagulants be restarted?

Answer 13

2-4 weeks after stabilization of ICH

Question 14

If antifibrinolytic therapy is started for aneurysm antifibrinolytic therapy should not continue past __ hours

Answer 14

72

Question 15

What calcium channel blocker is used to decrease complications associated with vasospasm?

Answer 15

nimodipine

lipophilic DHP CCB

Question 16

Hypertensive intracranial hemorrhage VTE prophylaxis should be started within _ to _ hours of a stable head CT

Answer 16

24, 72

Question 17

VTE prophylaxis with aneurysmal subarachnoid hemorrhage should begin within __ ours after SAH secured

Answer 17

24

Question 18

A 64 year old female presents with a sudden onset headache. (worst of her life). Upon CT head imaging it is determined she has an aneurysmal SAH. Which of the following meds should be started to decrease potential complications from delayed cerebral ischemia?

a. nicardipine
b. tranexamic acid
c. enoxaparin
d. nimodipine

Answer 18

d. nimodipine

Question 19

what is main drug for hyperosmolar therapy?

Answer 19

mannitol

Question 20

Serum osmolality should be. kept below ___ mOsm/kg

Answer 20

320

Question 21

Hypertonic saline for TBI should be filtered

a. true
b. false

Answer 21

b. false

mannitol should be filtered, but hypertonic saline does not have to be

Question 22

Which paralytic is useful in TBI b/c it can be given without regard to liver or kidneys?

Answer 22

cisatracurium

Question 23

What is recommended Tx for VTE prophylaxis in TBI pts?

a. LMWH or subQ UFH
b. mechanical prophylaxis
c. both

Answer 23

c. both

can start within 24hrs of a stable CT head scan

Question 24

What is the only drug that has been shown to decrease early post traumatic seizures (PTS)?

Answer 24

phenytoin

Question 25

Evidence shows an increase in mortality with TBI when what steroid is used?

Answer 25

methylprednisolone corticosteroids should not be used post TBI unless needed for another indication

Question 26

Seizure prophylaxis with phenytoin or levetiracetam may reduce complications associated with __ post-traumatic seizures a. early b. late

Answer 26

a. early

Question 27

Glasgow coma scale score of ___ indicates severe brain injury

Answer 27

3-8

Question 28

Glasgow coma scale score of _ indicates moderate brain injury

Answer 28

9-12

Question 29

Glasgow coma scale score of __ indicates minor brain injury

Answer 29

13-15

Question 30

What is goal systolic blood pressure for TBI in pts age 50-69?

Answer 30

> 100mmHg

Question 31

What is goal systolic BP for TBI in pts age 15-49 and 70+?

Answer 31

>110mmHg

Question 32

What is recommended target cerebral perfusion pressure for TBI?

Answer 32

60-70mmHg avoid aggressively attempting to increase CPP > 70mmHg

Question 33

Initiate medical treatment for TBI at what intracranial pressure?

Answer 33

> 22mmHg

Question 34

Guidelines recommend a MAP of ___ mmHg for 7 days following spinal cord injury

Answer 34

> 85-90 use vasopressors if needed

Question 35

Complications of spinal cord injury: Unopposed vagal tone often leads to severe cardiac arrhythmias including ___

Answer 35

bradycardia and rarely supraventricualr tachycardia or ventricular tachycardia