Acute Intracranial Problems

Question 1

What are the upper and lower MAP limits in which autoregulation is effective in managing cerebral blood flow?

Answer 1

50 and 150 mm Hg of MAP

Question 2

CPP = ?

Answer 2

CPP = MAP - ICP

Question 3

MAP = ?

Answer 3

1/3 systolic + 2/3 diastolic / 3

Question 4

Normal CPP range

Answer 4

70-100 mm Hg

Question 5

Cushing’s Triad

Answer 5

Systolic hypertension with widening pulse pressure
bradycardia with full and bounding pulse
Altered respirations
– Occurs with increased ICP and loss of auto-regulation
– Neurological emergency, herniation may be imminent

Question 6

PaCO2 will have what effect on CBF

Answer 6

Increase CBF

– CO2 is a vasodilator

Question 7

What is the most sensitive and reliable indicator in the patient’s neurological status?

Answer 7

LOC

Question 8

What are the three types of cerebral edema?

Answer 8

Vasogenic
Cytotoxic
Interstitial

Question 9

What are the three categories on the GCS

Answer 9

Eyes open (4)
Verbal response (5)
Motor response (6)

Question 10

“goal” for CPP, MAP, and ICP in regards to care for acute intracranial problem patients

Answer 10

CPP > 70
MAP > 90
ICP < 15

Question 11

What are some complications of increased ICP (4)

Answer 11

Inadequate cerebral perfusion
Cerebral herniation
Diabetes insipidus
SIADH

Question 12

What are some S/S of Increased ICP (6)

Answer 12

• LOC change
• Pupillary changes and vision dysfunction
• Motor strength and function
• Vital signs (Cushing’s triad)
• Vomiting and headache
• Seizures

Question 13

On Exams – what three things trump airway?

Answer 13

1) assessing the patient
2) Alerting people/calling for help
3) safety

Question 14

What is the most serious complication of a traumatic head enjury?

Answer 14

Epidural hematoma – may be an arterial bleed; perfuse; medical emergency –> Increased ICP; straight to the OR
– less serious may be a subdural hematoma, which will often be a venous bleed (much slower bleed); may take up to 3 days for effects to set in