Acute intracranial problems

Question 1

Normal ICP

Answer 1

5-15mmHg, we do something at 20

Question 2

CPP equation

Answer 2

MAP-ICP

Question 3

two main causes of vasoconstriciton

Answer 3

increase in CO2 (decrease in pH) or decreased O2

Question 4

Cushings triad

Answer 4

Widening pulse pressure, then decreased HR with FULL BOUNDING pulse, then decrease in RR

Question 5

Why is the pulse in cushing triad full and bounding?

Answer 5

It’s not a fluid problem, but a pumping problem

Question 6

Ipsilateral vs contralateral symptoms of increased ICP

Answer 6

change in pupils will be ipsilateral, while the motor function will be contralateral.

Question 7

decorticate posturing signals injury to what

Answer 7

cerebral cortex injury

positioned with arms over chest

Question 8

decerebrate posturing

Answer 8

means there is an injury to the brainstem (VERY bad)

Question 9

Where do you position the transducer in ICP monitoring

Answer 9

Place at tragus of ear

Question 10

how do you read the pressure with the transducer?

Answer 10

you want to close clamp 5-10 min before reading to ensure accuracy

Question 11

Normal ICP waveform

Answer 11

Peaks decend from P1 P2 to P3

Question 12

What will the waveform look like with increased ICP?

Answer 12

P2 wave will rise above the P1 peak

Question 13

Which device allows you to measure temperature and oxygenation of the brain?

Answer 13

Licox, placed in the healthy white matter of the brain

-Can also measure SJVO2 (55-75%)

Question 14

Range for PbtO2

Answer 14

20-40mmHg

Question 15

Drugs used for increased ICP

Answer 15

rapid-acting opioids, propofol is also good

-dont use long lasting benzos

Question 16

Mannitol

Answer 16

Used for increase ICP

-watch for massive fluid overload, monitor F/E closely

Question 17

Hypertonic saline

Answer 17

also used for increase in ICP

Question 18

common symptoms of coup/countercoupe injury

Answer 18

high BP, amnesia, HA

Question 19

Most serious skull fracture

Answer 19

Basilar, example-ears, nose, around eyes

Question 20

Why are basilar fractures most serious?

Answer 20

Can have high risk of meningitis

Question 21

What medication do you give for a head injury for pain?

Answer 21

Only tylenol

Question 22

What are impt signs of bacterial meningitis?

Answer 22

Kernig’s (flex hip, can straighten leg) and Brudzinskis (bend neck, knees bend) test

Question 23

Why is viral meningitis better to have?

Answer 23

Usually mild and self-limiting

-give abx until confirmed that it is viral

Question 24

Decreased LOC with ipsilateral fixed dilated pupil is a sign of what?

Answer 24

subdural hematoma

Question 25

S/S of epidural hematoma

Answer 25

initial decrease in LOC, brief lucid period, then decrease LOC again. this is very bad

Question 26

Dx of bacterial meningitis

Answer 26

purulent CSF. Labs have high protein, low glucose.