35. brain injury

Question 1

fluid therapy of choice for brain injured patient

Answer 1

1. hypertonic saline (do not give alone if dehydrated)Na doesn’t readily cross BBB therefore it may reduce cerebral edema thru osmotic pullalso has positive ionotropic effects2.synthetic colloid3. isotonic crystalloids4. blood products

Question 2

goal ventilatory rate for brain injured patient

Answer 2

10-20 bpm should keep PaCO2 btwn 25-35 mm HgpaCO2 < 30 mm Hg causes cerebral blood flow vasoconstriction and potential ischemia

Question 3

oxygen and head elevation for brain injured patient

Answer 3

oxygen supplementation—YES!head elevation 15-30 degrees to facilitate venous drainage from brain

Question 4

mannitol MOA for brain injured patient

Answer 4

osmotic diuretic–effect within 15-30 min0.5-1.5 g /kg, warmeddecreases intracranial pressure through reflex vasoconstriction of brain vasculature (decreases blood viscosity, decreases CSF production, free radial scavenger, osmotic pull of edema into intravascular space)

Question 5

T/F hyperglycemia in dogs and cats has been found to be a negative prognostic factor

Answer 5

FALSEin people, hyperglycemia has been shown to increase mortality in head trauma casesin one vet study, the degree of hyperglycemia was correlated with severity of injury however an association btwn level of hyperglycemia and outcome was NOT found

Question 6

modified glasgow coma score

Answer 6

higher number (18) = normallower number (3) = severe neuro deficitstakes into account motor activity/reflexes, brainstem reflexes, and level of consciousness/mentation

Question 7

MGCS and prognosis

Answer 7

3-8 GRAVE9-14 GUARDED15-18 GOODJVIM 2001 Platt et al