Coma and ICP

Question 1

Greatest danger in neurologic disease

Answer 1

Intracranial Pressure (ICP)

Question 2

Progression of increased ICP

Answer 2

Headache
Vomiting
Decreased Sensorium
Herniation
Brain Death

Question 3

Cushing Phenomenon

Answer 3

Increased ICP = Increased BP + Decreased HR

Question 4

Relationship of ICP and sensorium

Answer 4

Inversely proportional
The higher the ICP, the lesser the sensorium and vice versa

Question 5

Levels of Sensorium

Answer 5

Awake/Alert
Drowsy/Lethargic/Obtunded
Stupor
Coma/Unconscious

Question 6

pressure of all substances in the cranium

Answer 6

Intracranial Pressure

Question 7

The amount of blood flow that goes up the brain

Answer 7

Cerebral blood flow

Question 8

amount of blood that enters the brain every minute

Answer 8

700 mL

Question 9

power or force that drives blood into the brain

Answer 9

Cerebral Perfusion Pressure

Question 10

Cerebral perfusion pressure formula

Answer 10

Systolic BP - ICP

Question 10

relationship of ICP and systemic BP

Answer 10

Directly proportional
If ICP goes up, BP goes up and vice versa

Question 10

Components of intracranial pressure

Answer 10

Brain parenchyma
Blood volume
CSF

Question 10

Causes of increased brain parenchyma

Answer 10

cerebral edema
brain tumors
damaged neuron and glial cells

Question 10

A complication of increased ICP

Answer 10

herniation

Question 10

2 components of herniation to occur

Answer 10

opening
something that enters through the opening

Question 11

common areas where herniation occurs

Answer 11

uncus of temporal lobe
tonsils of lower cerebellum

Question 11

openings in the brain

Answer 11

tentorial notch
foramen magnum

Question 12

where the diencephalon connects c the midbrain

Answer 12

tentorial notch

Question 13

tonsils from the medial part of the cerebellum will come down and pass through the foramen magnum

Answer 13

tonsillar herniation

Question 13

where the medulla connects with the cervical spinal cord

Answer 13

foramen magnum

Question 13

signs of tonsillar herniation

Answer 13

decreased sensorium
apnea
icreased ICP

Question 13

two-sided herniation

Answer 13

decreased sensorium
bilateral medial rectus palsy
bilateral dilating non-reactive pupils

Question 13

one sided herniation

Answer 13

uncal herniation

Question 13

intervals when are osmotic diuretics given

Answer 13

Q4 (every 4 hrs)

Question 13

signs of uncal herniation

Answer 13

decreased sensorium
cn 3 damage
ipsilateral medial rectus palsy
ipsilateral non-dilating pupil
ipsilateral ptosis

Question 13

additional factors of increased ICP

Answer 13

increased cerebral blood flow
hypercapnia (increased CO2)
Fever
hypervolemia - too much fluids
restlessness

Question 13

interventions or controlling ICP

Answer 13

elevate head 15-30 degrees
control fever aggressively
ventilatory support
osmotic diuretics (mannitol and hypertonic saline)
dexamethasone

Question 14

more flexible diuretic

Answer 14

hypertonic saline

Question 15

diuretic that works well with vasogenic edema

Answer 15

mannitol

Question 16

side effects of dexamethasone

Answer 16

bleeding in stomach
increased risk for infection

Question 17

normal osmolality

Answer 17

280 mL

Question 18

osmolality when using osmotic diuretics

Answer 18

1000-9000 mL