CNS Trauma Flashcards
Where do spinal injuries usually occur?
- transverse process
- spinous process
What are the types of CNS bleeds?
- intracerebral
- subarachnoid hemorrhage
- epidural hematoma
- subdural hematoma
How is a subarachnoid hemorrhage
diagnosed?
CT scan
What is an epidural hematoma?
rapidly expanding with arterial blood; skull fracture present
What is a subdural hematoma?
slowly expanding with venous blood
What is a normal ICP?
5-15 mmHg
What can elevated ICP lead to?
brain herniation –> brainstem injury
What is CPP?
pressure gradient driving blood flow to the brain
What is a normal CPP?
50-70 mmHg
What is the equation for CPP?
CPP= MAP-ICP
What is used to categorize the severity of trauma but not diagnostic?
Glasgow Coma Scale (GCS)
What score on the Glasgow Coma Scale indicates less severe injury?
higher scores
What is our goal ICP when treating bleeds?
<20-22 mmHg
What agent can be used to reduce ICP?
- Mannitol 0.25-1g / kg IV bolus usually given via peripheral line using 0.22 micron filter
- Hypertonic saline 3%, 23.4% preferably given via central line
How is BP managed with CNS trauma?
- want systolic >100mmHg
- crystalloid fluids (avoid D5W and 1/2 NS)
- vasopressors as needed
What agent can be used during refractory elevated ICP to reduce cerebral blood flow and cerebral oxygen consumption?
Phenobarbital
What is our target Na range when dealing with CNS trauma?
145-155 mEq/L
How long is seizure prophylaxis given after CNS trauma?
7 days
How long does the patient remain on antiepileptic therapy if they had a seizure due to CNS trauma?
Lifelong
What is our target MAP for spinal trauma?
85-90 mmHg for first 7 days
What agents are used to maintain a target MAP after spinal trauma?
- fluids
- vasopressors (epi, norepi, dopamine)
