T3: Neurological PPT

Question 1

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

Answer 1

Developing bones and muscles

Question 2

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

Answer 2

Large

Question 3

Infant: How are neck muscles?

Answer 3

Poorly developed

Question 4

Infant: How are the thin cranial bones?

Answer 4

Not well developed; unfused sutures

Question 5

Infants: Skulls expands until age __

Answer 5

2 years

Question 6

Infants are prone to brain injury and skull fracture with ___

Answer 6

Falls

Question 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?

Answer 7

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

Question 8

Moro reflex

Answer 8

Startle

Question 9

Walking reflex

Answer 9

Stepping

Question 10

Plantar reflex

Answer 10

Stroke foot and toes curl

Question 11

Babinski reflex

Answer 11

Stroke side of feet ad toes fan out

Question 12

Galant reflex

Answer 12

Infant swings to the side that is stroked

Question 13

Tonic neck

Answer 13

Fencing

Question 14

Cranial valute finite

Brain?
CSF?
Blood?

Answer 14

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

Question 15

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

Answer 15

True

Question 16

T/F: Infants handle increased ICP better than adults

Answer 16

True

Question 17

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

Answer 17

Awakening, eating

Question 18

ICP signs: What are some other signs?

Answer 18

• Vomiting
• Personality changes
• Irritability
• Fatigue
• Gait changes

Question 19

ICP signs: What kind of vision?

Answer 19

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

Question 20

ICP signs: Is seizure a sign?

Answer 20

Yes

Question 21

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

Answer 21

Increased head circumference, bulging fontanels

Question 22

ICP signs: How does LOC change?

Answer 22

Sleepy then to coma

Question 23

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

Answer 23

• Bradycardia
• High BP
• Slow breathing

Question 24

ICP-late signs: What happens with Bradycardia?

Answer 24

Widening pulse pressure; slow HR

Question 25

ICP: late sign--Increased or decreased BP?

Answer 25

Increased

Question 26

ICP: late sign- Regular or irregular breathing?

Answer 26

Irregular

Question 27

A Glascow Coma Scale of ____ or less indicates poor outcomes

Answer 27

8 or less

Question 28

What are the levels of consciousness for LOC?

Answer 28

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

Question 29

What happens with lethargy?

Answer 29

Falls asleep quickly

Question 30

What happens with obtunded?

Answer 30

Arousable with stimulation

Question 31

What happens with stupor?

Answer 31

Deep sleep, responds to vigorous, repeated stimulation

Question 32

What happens with coma?

Answer 32

No response or decerebrate posturing to pain

Question 33

What happens with persistent vegetative state?

Answer 33

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

Question 34

Come + apnea =?

Answer 34

Brain death

Question 35

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

Answer 35

Absent brainstem fucntion Pupils= fixed, dilated No oculovestibular response No reflexes

Question 36

Brain death: are you hypothermic?

Answer 36

No

Question 37

Brain death: Are you hypertensive?

Answer 37

No

Question 38

How is brain death determined?

Answer 38

2 EEGs and 2 exams, 24 hours apart

Question 39

Physical exam: What are the most important aspects?

Answer 39

V/S

Question 40

PE: What does pinpoint pupils mean?

Answer 40

MSO4 or poisoning

Question 41

PE: What does fixed and dilated pupils mean?

Answer 41

Brain herniation

Question 42

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

Answer 42

Medical emergency!

Question 43

PE: What does unilateral fixed and dilated pupil?

Answer 43

Lesion on the same side; impending herniation

Question 44

PE: What is Doll's Eye Assessment?

Answer 44

Unconscious child

Question 45

What is decorticate positioning?

Answer 45

Cerebral cortex--above the brainstem Turn in toward the cord

Question 46

What is decerebrate positioning?

Answer 46

Midbrain or brainstem problem--limbs turn out

Question 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?

Answer 47

No, poor sign!

Question 48

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

Answer 48

ONLY as needed

Question 49

What does ICP monitoring do?

Answer 49

Tells amount of pressure build up in the head

Question 50

How is ICP treated?

Answer 50

Mannitol and steroids

Question 51

For ICP how should the positioning of child be?

Answer 51

- Avoid neck compression - Keep head midline - HOB elevated

Question 52

What is the last sense to be lost with coma?

Answer 52

Hearing