38 Trauma SNC Flashcards

aulas 8-9

1
Q

Medidas em caso de PIC elevada sem melhora com Manitol, Salina, otimização de analgesia, da sedacao e DVE?

A

Medir a Sat Venosa Central.

  1. Coma barbiturico
  2. Hiperventilacao agressiva
  3. Craniectomia
  4. Laparotomia - se PIA > 20mmHg
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2
Q

Long-term outcome cannot be pre- dicted from TBI; thus full resuscitative efforts should be ini- tiated and continued, even in the most severely injured. (…) In patients with bilateral fixed and dilated pupils, a good outcome was still seen in 8% of patients.

  • V ou F
A

Verdadeiro

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3
Q

In a recent review of the Trauma Registry of the German Society for Trauma Patients looking at over 50,000 patients, out- come prediction was most accurate using: (2)

A
  • GCS motor score
  • Pupil reactivity.
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4
Q

Como é o processo fisiopatologico de lesao secundaria no TCE?

A
  • Falencia metabolica
  • Estresse oxidativo
  • Cascata de eventos bioquímicos e moleculares
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5
Q

Quais sao os parametros gerais a serem controlados em todos os pacientes com TCE grave? (7)

A
  • PAM
  • PETCO₂
  • Ht
  • Na
  • Profilax TVP
  • Nutricao
  • Anticonvulsivantes
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6
Q

Quais sao as intervenções iniciais no paciente com TCE Grave? (8)

A
  • ABC do trauma
  • PaCO₂ 35
  • O₂ Suplemenentar
  • Elevar cabeceira
  • Alinhar cabeca e pescoco
  • Antinocicepcao
  • Normotermia
  • Sedacao
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7
Q

Quando o paciente apresentar elevacao súbita da PIC inexplicada ou ocorrer alteracao do status mental, quais as condutas? (3)

A
  • Gasometria Arterial
  • Posicionamento
  • Considerar nova TC
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8
Q

A single episode of hypoxemia (PaO2 < 60 mm Hg) occurring in a patient with severe TBI can double the inci- dence of mortality

  • V ou F
A

Verdadeiro

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9
Q

Brain tissue hypoxia may be corrected by _____(4)_____
if increased ICP results in decreased cerebral blood flow.

A
  • ↑FiO₂
  • Hemotransfusao
  • Inotropico
  • Sedacao
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10
Q

The most challenging of all trauma patients are those with severe TBI and coexisting hemorrhagic shock. A single episode of hypotension, defined as systolic blood pressure lower than 90 mm Hg, is associated with an increase in morbidity and doubled mortality after severe TBI.

  • V ou F
A

Verdadeiro

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11
Q

Primary injury to the spinal cord sustained at the time of injury may be exacerbated by secondary factors: (2)

A
  • Hipoperfusao sistemica
  • HIpoxia

The combination of biochemical changes, vas- cular disruption, and electrolyte abnormalities can lead to cellular changes and worsening of SCI lesions up to 3 days after injury. SCI includes sensory deficits, motor deficits, and both.

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12
Q

Qual a diferenca de choque neurogênico e choque espinhal?

A
  • Neurogenico: perda to tonus simpatico e de fibras cardioaceleradoras
  • Espinhal: Perda da funcao neurologica abaixo da lesao
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13
Q

Qual o motivo do Choque Neurogenico apresentar Bradicardia?

A
  • Perda da funcao cardioaceleradora
  • Tonus parasimpatico sem oposicao
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14
Q

Uma vez controlada a hemorragia, qual o valor alvo da PAM para choque neurogênico?

A

PAM > 85mmHg por 7 dias

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15
Q

Principais tratos dorsais da medula e pelo que sao responsáveis (2)

A

Propriocepção, tato discriminativo e vibração.

  • Gracil
  • Cuneiforme
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16
Q

Principais tratos anteriores e laterais da medula e pelo que sao responsaveis (5)

A
  1. Espinotalamico
  2. Espinocerebelar
  3. Cortico-espinhal
  4. Rubro-espinhal
  5. Reticulo-espinhal

Motor, Dor, temperatura, tato grosseiro, tonus muscular.