Case 10: Cerebral Aneurysm Flashcards
1
Q
How can you tell a patient has increased ICP?
A
Look for clinical signs
Cushing triad
- HTN
- Bradycardia
- Change in respiratory pattern
Also look for signs of headache, papilledema, N/V, altered mental status
- Widened pulse pressure
2
Q
Complications associated with cannulation of internal jugular vein?
Complications associated with cannulation of carotid artery?
A
Jugular Vein
- PTX
- Hematoma
- Cardiac perforation/tamponade
- Thrombosis
- Infection
- Dysrhythmai
Carotid Artery
- Hematoma
- Airway obstruction
- Stroke
- AVF
- Hemothorax
3
Q
Benefits of using a pulmonary artery catheter?
A
- Differentiation among causes of shock
- Differentiaon between mechanisms of pulmonary edema
- Evaluation of pulmonary hyertension
- Diagnosis of pericardial tamponade
- Unexplained dyspnea
4
Q
How would you induce and intubate patient with heart failure and difficult airway management (c spine fracture etc.)?
A
- Ensure difficult airway equipment in the room
- Optimize volume status to avoid significant hypotension that would be poorly tolerated in setting of CAD
- Provide adequate airway analgesia and administer fentanyl and IV lidocaine to blunt the sympathetic response associated w/ intubation
- Perform awake fiberoptic intubation
- Achieve slow controlled induction w/ fentanyl and propofol
- Administer non depolarizing muscle relaxant
- ensure deep plane of anesthesia prior to insertion of head pins.
5
Q
What is neurogenic pulmonary edema?
A
- Usually develops within minutes to hours following CNS injury
- A massive sympathetic surge generated by the injured CNS results in generalized vasoconstriction and redistribution of blood volume to the pulmonary circulation.
- It remains uncertain wheter the subsequent capllary leak is produced by the pressure induced mechanical injury from elevated capillary hydrostatic pressure or because of some direct nervous system control of pulmonary capillary permeability.
