10-15 L3 SHI (management)

Question 1

CPP

(cerebral perfusion pressure)

Answer 1

CPP=MAP -ICP

• MAP= (SP + (DPx2))/3
• ICP> 20 = kiss of death
• The pressure gradient that delivers the arterial blood along with sugar and oxygem to the intracranial cavity.

Question 2

What is autoregulation?

What organs can produce it?

Under what level do we lose autoregulation (CPP)?

Answer 2

• autoregulation:
  
  • is the ability of the brain to maintain normal CBF over a wide range of systemic blood pressures.
• Kidney
• When CPP falls be_low a level of 60 mmHg_ the brain begins to lose autoregulation

Question 3

Hypotension in the prescense of SHI will cause what according to morbidity and mortality?

Answer 3

• will signficiantly increase the modbidity and mortality

Question 4

The factor most indicative of outcome in SHI is?

Answer 4

• proportion of ICP measurements greather than 20 mmHg
• Next: BP (measurements less than 80 nnHg)

Question 5

Glasgow Coma scale

Answer 5

• commonly used to evaluate patients
• excellent triage tool
• Good indicator of severity of injury
• not good neuroassesment
  
  • doesn;t assess brainstem function
  • doesn’t asses bilateral motor function
  • pt can deteriorate with no change in GCS.

Question 6

What are the 3 types of motor responses in an unconscious patient?

Answer 6

• appropriate: purposeful or localizing
• inappropriate: decorticate and decerebrate
• absent

Question 7

What is the purpose of motor evaluation?

Answer 7

• determines severity of brain injury
• area of the brain compromised by the injury

Question 8

What are some ideal short acting drugs used for intubating a patient?

Answer 8

• Cisatracurium (Nimbex)
• Vecuronium (Norcuron)

Question 9

What will reduce ICP (when ICP are elevated)

Answer 9

Acute, short-term hyperventilation will reduce ICP rapidly

Question 10

In treatment for MAP what are the prefeered agents in sedatives and analgesics?

Answer 10

• Propofol (unconciousness, Diprivan)
• Fentanyl (analgesia, Sublimaze)

Question 11

What are clinical signs of transtentorial herniation?

Answer 11

• Sudden deterioration of L.O.C.
• Pupillary change
  
  • blown pupil
• Sudden deteriortaion of motor response
  
  • almost alway son the side opposite to the blown pupil

Question 12

What is the treatment for transtentorial herniation?

Answer 12

• Acute-short term hyperventialtion
• Mannitol (1 g/kg rapid bolus)
• CT scan stat
• Alert O.R.
• Get head opened up as fast as possible