Cerebral Perfusion + Adrenal Issues Flashcards
Vasogenic VS Cytotoxic
cerebral edema
Vasogenic: BBB is compromised
- Head injury, hematoma, hemorrhage, infection
Cytotoxic: increase in ICP => increase shift into ICF
Combo: head injury»_space; hemorrhage»_space; ischemia
What is the calculation of CPP?
What are normal ranges?
CPP = MAP - ICP
CPP = 60-80 mmHg (need at least 50 mmHg) ICP = 5-15 mmHg; >20 mmHg = cerebral necrosis MAP = 70-100 mm Hg
What is the priority tx for cerebral edema?
Treating the UNDERLYING CAUSE
What is CVA?
Cardiovascular attack aka STROKE
- A complete block of artery.
Ischemic CVA
- Incidence; common location/deficits
- What is the tx? (3)
Thrombus/embolus deprives brain of blood.
- 80% of CVA
- Has TIA
- Commonly in middle cerebral artery (MCA) = DEFICITS IN UPPER LIMBS + FACE
TREATMENT
- Thrombolytics (<3 hrs since onset of s/s)
- Carotid endarterectomy (taking out clot from carotid artery)
- Angioplasty
Hemorrhagic CVA
- Incidence?
- Notable RFs?
- Notable S+S?
- Tx?
Blood vessel ruptures.
- Less common, but more fatal!
- RFs: Hemophilia, AVM, aneurysm
- Sudden onset of s/s (“worst headache of their life”)
Tx
- FOCUS ON STABILIZING (optimize perfusion; surgical evacuation)
- Osmotic diuretics (Mannitol) OR Hypertonic NS (3% NaCl)
Transient Ischemic Attack (TIA)
Angina of the brain; “mini strokes” - when cerebral artery is temporarily blocked
- Risk of ischemic CVA
- Should be on stroke prevention
Signs of stroke (CVA)
Face drooping
Arms - unable to raise both up
Speech is slurred/jumbled
Time - call 911 asap!
Hemophilia
What is it a RF for?
A bleeding disorder that lacks coagulating factors.
- RF for hemorrhagic CVA
Arteriovenous malformation (AVM) - S/s; Tx
Congenital defect in structural formation of cerebral vessels in capillary network
- Increased risk of rupture (hemorrhage).
s/s
- Ischemia (steals O2 from surrounding vessels)
- Slow onset of neuro deficits
Tx:
- Surgical removal
- Radiation (gamma knife)
- Embolization
Aneurysm
- What are s/s are dependent on?
- Types
- Ruptures
- Tx; what if a pt has a high risk for clotting?
A bulge/distended artery from weakened arterial walls (located dilation of BV).
S/s: depends on affected location
Types:
- Cerebral @subarachnoid space (80% in Circle of Willis)
- Aorta abdominal (AAA): older age = less elastin
- *LISTEN FOR BRUITS**
- Thoracic (chest)
Ruptures:
Cerebral = hemorrhagic CVA
Aorta = systemic bleed out (surgery, fluids ASAP!!)
Tx
- Surgery (clipping; coiling)
- Meds: THROMBUS PROPHYLAXIS
- Antiplatlets (ASA, Clopidogrel) pre to post-3 m.
* *unless high risk for clotting, then Heparin before antiplatelets** - MRI follow-up
- Smoking cessation, tx other associated conditions
Cardiac tamponade
- Notable S/S?
- Tx?
Coronary artery bursts causing fluid build-up in pericardium.
S/S:
- PULSUS PARADOXUS (SBP drops on inspiration)
- Hypotension
Tx
- *PERCARDIOCENTESIS (inserting needle into pericardium + withdrawing fluid)
- Stabilize
Intracerebral hematoma
Within cerebral lobes
- Caused by anything hemorrhagic
Epidural hematoma
B/w dura + skull
- Commonly d/t SKULL FRACTURE
- Very acute; life-threatening
Subdural hematoma
B/w dura + subdural space
- Commonly d/t ACCEL/DECEL injuries = venous tearing
Acute: sudden onset; high m+m d/t high ICP
Subacute: slower onset; same danger
Chronic: very slow onset d/t brain atrophy = shrinking = venous tearing (HIGH RISK OF PT DYING AT HOME AFTER DISCHARGE)
Pulsis paradoxus
A symptom of Cardiac tamponade where SBP decreases with inspiration.
(b/c when lungs fill, there is less space for the heart to pump)
Mannitol & Isosorbide
- MOA?
- Tx?
Osmotic diuretics
- Pulls H2O into circulation of renal tubules
- Inhibits Renin release
Tx: cerebral edema + intraocular HTN (esp. hemorrhagic CVA)
Adrenal synthesis + secretions
Cortex: Steroid hormones (cortisol, aldosterone, andorgens)
Medulla: catecholamines
Describe the insufficiency of cortisol in athletes + s/s.
Repeated stress = repeated secretions of cortisol = depletion in cortisol stores
s/s:
- Salt cravings (less Na retained bc of lowered adrenal fx)
- Hyponatremia
- Fatigue
- Hypoglycemia (b/w meals; post-workout)
Keto diet
- What risks are there?
- Risk for diabetic pts
High fat + proteins, no carbs.
- Results in increase in fat breakdown = increase in ketones produced = decrease in blood pH = ketoacidosis
Diabetic pts: Increases insulin resistance
Pulmonary HTN
- Primary vs Secondary
- Tx?
When the pressure from BV to lungs is too high.
Primary (hereditary, ideopathic; i.e. low NO production)
Secondary: d/t existing disease
Tx: NIPRIDE
*Prevent secondary injury = COR PULMONALE (RS heart failure)
Carotid endarterectomy
Tx for ischemic CVA in which a clot is directly removed from a carotid artery.
Percardiocentesis
Tx for Cardiac Tamponade - inserts needle into pericardium + withdraw fluid
