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Critically Ill > CNS Trauma > Flashcards

CNS Trauma Flashcards

1
Q

Where do spinal injuries usually occur?

A
  1. transverse process
  2. spinous process
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2
Q

What are the types of CNS bleeds?

A
  1. intracerebral
  2. subarachnoid hemorrhage
  3. epidural hematoma
  4. subdural hematoma
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3
Q

How is a subarachnoid hemorrhage
diagnosed?

A

CT scan

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4
Q

What is an epidural hematoma?

A

rapidly expanding with arterial blood; skull fracture present

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5
Q

What is a subdural hematoma?

A

slowly expanding with venous blood

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6
Q

What is a normal ICP?

A

5-15 mmHg

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7
Q

What can elevated ICP lead to?

A

brain herniation –> brainstem injury

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8
Q

What is CPP?

A

pressure gradient driving blood flow to the brain

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9
Q

What is a normal CPP?

A

50-70 mmHg

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10
Q

What is the equation for CPP?

A

CPP= MAP-ICP

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11
Q

What is used to categorize the severity of trauma but not diagnostic?

A

Glasgow Coma Scale (GCS)

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12
Q

What score on the Glasgow Coma Scale indicates less severe injury?

A

higher scores

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13
Q

What is our goal ICP when treating bleeds?

A

<20-22 mmHg

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14
Q

What agent can be used to reduce ICP?

A
  1. Mannitol 0.25-1g / kg IV bolus usually given via peripheral line using 0.22 micron filter
  2. Hypertonic saline 3%, 23.4% preferably given via central line
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15
Q

How is BP managed with CNS trauma?

A
  1. want systolic >100mmHg
  2. crystalloid fluids (avoid D5W and 1/2 NS)
  3. vasopressors as needed
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16
Q

What agent can be used during refractory elevated ICP to reduce cerebral blood flow and cerebral oxygen consumption?

A

Phenobarbital

17
Q

What is our target Na range when dealing with CNS trauma?

A

145-155 mEq/L

18
Q

How long is seizure prophylaxis given after CNS trauma?

A

7 days

19
Q

How long does the patient remain on antiepileptic therapy if they had a seizure due to CNS trauma?

A

Lifelong

20
Q

What is our target MAP for spinal trauma?

A

85-90 mmHg for first 7 days

21
Q

What agents are used to maintain a target MAP after spinal trauma?

A
  1. fluids
  2. vasopressors (epi, norepi, dopamine)

Critically Ill (20 decks)

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