T3: Neurological PPT Flashcards Preview

Pediatrics-MJ > T3: Neurological PPT > Flashcards

Flashcards in T3: Neurological PPT Deck (52):
1

Infants and young children are at higher risk for injury to the brain and spinal cord because of _____

Developing bones and muscles

2

Infant: Head is ___ in proportion to body (top heavy)

Large

3

Infant: How are neck muscles?

Poorly developed

4

Infant: How are the thin cranial bones?

Not well developed; unfused sutures

5

Infants: Skulls expands until age __

2 years

6

Infants are prone to brain injury and skull fracture with ___

Falls

7

Infants: Excessive spinal mobility; immature muscles, joint capsuel and ligaments of cervical spine; wedge-shaped, cartilaginous vertebral bodies; incomplete ossification of vertebral bodies--all this possess greater risk for what?

High cervical spine injury at C1-C2 level or vertebral compression fractures with falls

8

Moro reflex

Startle

9

Walking reflex

Stepping

10

Plantar reflex

Stroke foot and toes curl

11

Babinski reflex

Stroke side of feet ad toes fan out

12

Galant reflex

Infant swings to the side that is stroked

13

Tonic neck

Fencing

14

Cranial valute finite

Brain?
CSF?
Blood?

Brain: 80%
CSF: 10%
Blood: 10%

15

A change in one of these % [brain (80%), CSF (10%), or blood (10%)] means another change has to occur. True or False?

True

16

T/F: Infants handle increased ICP better than adults

True

17

ICP Signs: Headache on _____, in the absence of ____

Awakening, eating

18

ICP signs: What are some other signs?

-Vomiting
-Personality changes
-Irritability
-Fatigue
-Gait changes

19

ICP signs: What kind of vision?

Double or blurred, pupils react more slowly then dilate and come fixed

20

ICP signs: Is seizure a sign?

Yes

21

ICP signs: What kind of head circumference? What kind of fontanels?

Increased head circumference, bulging fontanels

22

ICP signs: How does LOC change?

Sleepy then to coma

23

ICP late signs: What are the parts of Cushing's Triad?

-Bradycardia
-High BP
-Slow breathing

24

ICP-late signs: What happens with Bradycardia?

Widening pulse pressure; slow HR

25

ICP: late sign--Increased or decreased BP?

Increased

26

ICP: late sign- Regular or irregular breathing?

Irregular

27

A Glascow Coma Scale of ____ or less indicates poor outcomes

8 or less

28

What are the levels of consciousness for LOC?

-Lethargy
-Obtunded
-Stupor
-Coma
-Persistent Vegetative stage

29

What happens with lethargy?

Falls asleep quickly

30

What happens with obtunded?

Arousable with stimulation

31

What happens with stupor?

Deep sleep, responds to vigorous, repeated stimulation

32

What happens with coma?

No response or decerebrate posturing to pain

33

What happens with persistent vegetative state?

Eyes open, limbs, spastic, no words, some swallow

34

Come + apnea =?

Brain death

35

Brain death is absent ____ function. How are pupils? What is the oculovestibular response? Any reflexes?

Absent brainstem fucntion

Pupils= fixed, dilated

No oculovestibular response

No reflexes

36

Brain death: are you hypothermic?

No

37

Brain death: Are you hypertensive?

No

38

How is brain death determined?

2 EEGs and 2 exams, 24 hours apart

39

Physical exam: What are the most important aspects?

V/S

40

PE: What does pinpoint pupils mean?

MSO4 or poisoning

41

PE: What does fixed and dilated pupils mean?

Brain herniation

42

Is brain herniation a medical emergency or a short ED visit?

Medical emergency!

43

PE: What does unilateral fixed and dilated pupil?

Lesion on the same side; impending herniation

44

PE: What is Doll's Eye Assessment?

Unconscious child

45

What is decorticate positioning?

Cerebral cortex--above the brainstem

Turn in toward the cord

46

What is decerebrate positioning?

Midbrain or brainstem problem--limbs turn out

47

Moro, tonic, and withdrawal are normal as a baby. Is this a normal sign for an older child too if they have those reflexes?

No, poor sign!

48

Unconscious child: ABC--how often do we suction if the are intubated?

ONLY as needed

49

What does ICP monitoring do?

Tells amount of pressure build up in the head

50

How is ICP treated?

Mannitol and steroids

51

For ICP how should the positioning of child be?

-Avoid neck compression
-Keep head midline
-HOB elevated

52

What is the last sense to be lost with coma?

Hearing

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