chapter 35

Question 1

neurogenic shock pathophysiology

Answer 1

The problem arises in the SNS which can’t regulate the diameter of the blood vessels
Vasodilation affects the resistance of the blood vessels
Decrease in systemic vascular resistance creates many problems: hypotension, venous blood pooling in the peripheral area, decreased cardiac output due to decrease cardiac preload & afterload, bradycardia
Risk for thrombosis
Hypothermia (core body temperature)
***without sympathetic tone, blood cannot efficiently flow throughout the body.

Question 2

neurogenic shock SNS

Answer 2

The SNS arises out of the ANS. The ANS controls Heart rate, blood pressure, digestion, respiratory rate, urination, etc.
SNS keeps us alive – “fight or flight”

SNS controls vasomotor tone which regulates diameter of the vessels.

Question 3

basilar skull fracture

Answer 3

raccoon eye bruise
Fracture in temporal bone of the middle ear, may involve brain injury
Battle’s sign
Bruising of mastoid process behind the ear on the affected side
CSF leak from the ear or the nose
Frontal fossa fractures
Can result in periorbital ecchymosis, referred to as raccoon eyes

Question 4

spinal shock is defined as

Answer 4

as a temporary condition following transection of the spinal cord that is characterized by muscular flaccidity & loss of motor reflexes in all parts of the body below the point of transection.

Life threatening complication
Correct movement of patient is critical to preventing additional injury/loss of function
Spinal shock occurs immediately after SCI
Immediate loss of function below the level of injury within 30-60 minutes to 6 weeks
ASSESSMENT findings:
Sever hypotension, bradycardia, warm skin/dry skin
Interventions: Steroids, Atropine, & IV fluids

Areflexia
Results from primary injury to the spinal cord
Flaccid muscles, paralysis, lack of sensation below injury, bowel and bladder dysfunction
Loss of the anal reflex or bulbocavernosus (muscle of the perineum) reflex
Autonomic function also disrupted
Can not assess extent of injury until spinal shock resolves, may take days to weeks
Indicated by return of anal reflex & bulbocavernosus reflex

Question 5

Epidural Hematoma

Answer 5

Most serious complication of head injury
Bleed in space below skull
Commonly caused by skull bone fracture lacerating middle meningeal artery
Voluminous arterial bleeding
Midline shift of brain can be viewed on imaging studies within an hour of injury
Injury leads to decreased LOC, followed by lucid period, and rapid deterioration

Critical that recognition of EDH occurs
Patient may present with severe headache, vomiting, seizure, pupil distortions, Cushing’s triad
CT scan
Skull x-ray (will often show fracture)
Neurosurgical emergency
Surgical evacuation of the hematoma

Question 6

subdural hematoma

Answer 6

Bleeding in space below the dura mater & above the arachnoid membrane
Usually due to tearing of bridging veins in subdural space
Most common type of traumatic intracranial hematoma
Slow bleeding, but blood can accumulate over time
Acute SDH: within 72 hours after head injury
Subacute SDH: take up to 7 days

Neurological deficits do not usually occur until substantial bleeding
Repeat follow-up neurological exams needed
Coagulation profiles
Anticoagulants, alcohol abuse
CT scan and skull x-ray
Large, acute SDH require craniotomy to evacuate blood
Small SDH may be slowly reabsorbed by brain

Question 7

ASIA

Answer 7

A = Complete
No sensory or motor function is preserved in sacral segments S4-S5.
B = Incomplete
Sensory, but not motor function is preserved below the neurological level and extends through sacral segments S4-S5.
C = Incomplete
Motor function is preserved below the neurological level, and most key muscles below the neurological level have muscle grade lower than 3.
D = Incomplete
Motor function is preserved below the neurological level, and most key muscles below the neurological level have muscle grade greater than or equal to 3.
E = Normal
Sensory and motor functions are normal.