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CTITICAL CARE > Neurological System > Flashcards

Flashcards in Neurological System Deck (45):
1

What is the best continuous sedative drip for intubated neuro patients

Propofol ( diprivan)

2

What part of the neuro exam is the best indicator of neurological deterioration

Changes in LOC

3

What are late signs of deteriorating neurological status

Fixed and dilated pupils
Decerebrate posturing

4

Cranial nerve 3

Oculomotor
EOM pupil constriction
Raises lowers eyelid

5

Cranial nerve 4

Trochlear
EOM
Down and in

6

Cranial nerve 6

Abducens
EOM
Lateral gazes

7

Cranial nerve V

Trigeminal
Sensory of face and mastication and corneals

8

Cranial nerve 9

Glossopharangeal
Posterior taste buds and innervates pharyngeal sensation

9

Cranial nerve 12

Hypoglossal
Tongue movements

10

What is the cerebellar responsible for

Gait and posture

11

What does the cerebellar exam consist of

Gait and posture
Heel to shin ( drag heel of one foot down the shin of opposite leg looking for uninterrupted contact)
Ataxia ( staggering, unsteady wide gait)
Dysmetria ( inability to control the range of movement in muscle action { past pointing}

12

Where is c4

At the clavicle
Innervates the diaphragm

13

Where is t4

At the nipple

14

Where is t10

At the umbilicus

15

Brain death testing

Dolls eyes
+ dolls eye is a good sign ( the eyes moves in the opposite direction the head was turned)
If the reflex is negative severe brain stem damage is indicated

16

Oculovestibular reflex

Infusion of ice cold water into the ear canal of a comatose patient
A intact brain stem will turn the eyes outward and downward from affected ear

17

A GCS 8 or less indicates what

Comatose

18

A GCS of 3 indicates what

Unresponsive

19

Central pain

Tells examiner what level the brain is functioning

20

Peripheral pain

Tells the examiner what level the cord is functioning

21

What's normal ICP

0-15

22

What is ICP

Pressure within the cranial volt

23

What is CCP

Cerebral perfusion pressure

24

What is normal CCP

60-80

25

How do u calculate CCP

MAP-ICP=CCP

26

What drain can calculate ICP

EVD

27

What is Cushing triad

HTN
Bradycardia
Widened pulse pressure

28

What is criteria for brain death

1.Pupils nonreactive ( usually dilated)
2. No protective reflexes ( cough, gag, corneals)
3. No respirations above what the vent provides
4. Core temp 36 degrees Celsius or above
5. PACO2 greater than 60
6. No movement of any kind to central pain
7. On no sedatives, paralytics, or barbiturates

29

Brain facts

Brain is totally dependent on oxygen and glucose for its metabolism
Receives 750 ml/min blood
Recieves 15-20% of resting cardiac output
Brain is supplied by 2 major arteries

30

What is a ischemic stroke

Occlusion of a blood vessel

31

What is a hemmorhagic stroke

Rupture of a blood vessel

32

What is penumbra

Zone of hypoperfused neuronal cells that are unable to function but remain viable
Located around the injury

33

What's a embolic stroke

Clots form elsewhere and travels to brain
Accounts for 15-20% of all ischemic strokes

34

Where's the origin of a embolic stroke

Cardiac origin
A fib, decreased heart valves, infectious endocarditis, cardiomyopathy

35

What's a thrombotic stroke

Atherosclerosis vessels narrow, the plaque may dislodge
TIAs may precede

36

What's the origin of a thrombotic stroke

HTN
Smoking
Diabetes

37

How do you diagnose a stroke

A CT to rule out hemmorhage is the gold standard ( should be done within 25 min)
CTA to identify acute vascular occlusion
Perfusion CT shows areas of perfusion and penumbra

38

What's the gold standard on examining cerebral circulation

Angiography

39

What may patients with a intercerebral hemmorhagic present with

Lateralized weakness, sensory symptoms, aphasia, visual field cuts
Headaches, vomiting,
Elevated systolic pressure
Coma and / or decreases in LOC

40

What is care of the intercerebral hemmorhage

Medical priorities to prevent hematoma expansion
Reverse anti coagulants ( vit k, FFP, Factor VIIa
BP management
Maintain CCP above 60 if monitoring ICP

41

What's a subarachnoid hemmorhage

Presentation of classic severe headache
May have loss of consciousness
Unchallenged rigidity or stiff neck
Photophobic, photophonic
N/V
Focal neurologic deficits

42

How do you diagnose SAH

Cerebral angiography do the gold standard
Non contrast CT
lumbar puncture
MRA
CTA to detect aneurysm

43

What are complications of SAH

Cerebral vasospasm
Hydrocephalus

44

What med is riven q4 hr to every SAH patient

PO CCB

45

What are strategies for ICP management

Bed 30 degrees
Suctioning
3% NS OR 1.5% NSS if peripheral line
Osmotic diuretic
Paralytic, sedation
Temp control, seizure control hypothermia