2: Neuro Emergencies Flashcards

1
Q

Which mentation change(s) indicate brainstem involvement?

A

Stuporous & comatose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are examples of systemic causes of mentation changes?

A

Toxins
Metabolic Issues
Cardiovascular Events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the treatment approach for mentation changes?

A

Correct Temp/metabolic derangements
Treat what you can at the moment (Toxin if applicable, blood pressure, etc)
Evaluate signs of increased ICP
Maintain CPP
Decrease ICP (Mannitol or Hypertonic, Craniectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are signs of increased ICP?

A

Cushing’s Effect
Pupil Changes
Proprioceptive/CN deficits
Decerebrate posture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the methods for decreasing ICP?

A

Decreasing edema: Mannitol or Hypertonic Saline
Increase space: Craniectomy or lesion removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What clinical signs do you see with the Cushings’ Reflex?

A

Severe hypertension with reflex bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Definition of Status Epilepticus?

A

Failure of seizure to terminate
Any seizure lasting >5 min or >2 seizures without return to normal consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some systemic effects of status epilepticus?

A

hypertension, tachycardia, arrhythmias, hyperglycemia, respiratory compromise, hyperthermia, acidosis, myoglobinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Death from status epilepticus is a result of which processes?

A

Brain herniation
Ventricular arrhythmias
Respiratory compromise
Renal failure (after days of myoglobinuria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the immediate treatment for status epilepticus?

A

Check temperature & initiate active cooling, O2 supplementation,
Anti-Seizure Drugs:
Fast: Diazapam or Midazolam; 3 failed benzos-> anesthetic dose of propofol
Long: Phenobarb/Keppra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why is it important to also start a long-acting seizure drug when treating status epilepticus?

A

Benzodiazepines only stay in the brain for ~5min.
Most patients will need a long term long acting anyway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the two major groups of etiologies of status epilepticus?

A

Reactive, Epileptic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are two major causes of reactive status epilepticus?

A

Metabolic & Toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the three categories of epilepsy?

A

EUC
Idiopathic
Structural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The first step in treating a traumatic brain injury is determined by what factor?

A

Is the patient seizing?
If yes, stop seizure
If no, systemic eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 categories evaluated by the Modified Glasgow Coma Score?

A

Motor Activity, Brain Stem Reflexes, Level of consciousness

17
Q

What are the tiered treatments of TBIs?

A

Tier 1- Fluid therapy, ventilation
Tier 2- Mannitol/Hypertonic, 30º Head Elevation
Tier 3- Surgical decompression, hyperventilation, hypothermia