Critical Care/ICU Monitoring Flashcards
What are five indications for critical care continuous EEG?
-diagnosis of Non-convulsiveand NCES or paroxysmal events
-efficacy of therapy for sz and SE
-identification of cerebral ischemia
-monitoring of sedation and high-dosesuppressive therapy
-assessment if severity of encephalopathy andprognostication
Once an ICU/critical patient is properly set up for continuous EEG, what do ACNS guidelines recommend that the technologist should do next?
-remain at bedside for first20 minutes to evaluate EEG patterns requiring urgent interp -examine behavior
-ensure acceptable data quality
-perform activations/test reactivity
· What things should be checked by the technologist daily for critical care continuous EEG recording?
-technical artifacts (at least 2x daily)
-impedance,
-electrode stability,
-patients skin for breakdown
-asses reactivity
How often should a patient’s skin be assessed in critical care EEG?
daily with written protocols on how and when to check and document
Rank by severity from LEAST to MOST sever: (A)Burst-suppression,(B) alpha coma, (C) spindle coma, (D) ECI, (E) high-voltage arrhythmic delta, (F)triphasic, (G) IRDA
IRDA, HVAD, triphasic, spindle coma, alpha coma, burst-suppression, ECI
How often should a cEEG be reviewed by a qualified enchepalographer for important events?
at least twice a day
The preferred term for referring to seizures without prominent motor activity
Nonconvulsive
DCI
Delayed Cerebral Ischemia, due to vasospasm after SAH. Usually causes wide spread EEG changes
ECMO
Extracorporeal membraneoxygenation. Requires ligation of the right common carotid artery and right jugularvein
GCS
Glascow Coma scale classifies the severity of TBI
Whatare four EEG features that are considered favorable prognostic features?
-background continuity
-spontaneous variability
-reactivity to stimulation
-presence of normal sleep patterns
HIE
Hypoxic-ischemic encephalopathy, major cause morbidity and mortality among term newborns
ICH
Intracranial hemorrhage
Nonconvulsive Seizure (NCS)
far more common than convulsive seizures in children
Electrographic Status Epilepticus (ESE)
electrographic seizure for>/ 10 continuous minutes or for a total duration of >/20% of any60-minute period of recording
BIRDs
> 4 Hz in frequency and >/ 0.5 to <10seconds induration
SAH
Subarachnoid Hemorrhage
TBI
Traumatic Brain Injury
Therapeutic Hypothermia (TH)
improved survival in comatose adults after cardiac arrest
SIRPIDs
Stimulus-induced rhythmic,periodic, or ictal-appearing discharges
What EEG findings are seen in intraventricular and subarachnoid hemorrhage?
Diffuse slowing and generalized, frontally predominant rhythmic delta (formerly FIRDA)
Rasmussen’s Encephalitis
Rare inflammatory neurological disease, typically affects one hemisphere, resistant epilepsy, progressive loss of motor/speech skills and hemiparesis with uni-hemispheric brain atrophy
Alpha coma
mostly frontal areas. Caused by intoxications, brainstem lesions and HIE
Beta coma
maximally frontal regions. Intoxication or withdrawal and severe hyperthyroidism, and brain lesions
Spindle Coma
predominant theta and delta background activity w/ super imposed, frequent, paroxysmal spindle-shaped bursts. TBI, ICH, intoxication, post-ictal states, hypoxic-ischemic encephalopathy
MELAS
Mitochondrialencephalopathy, lactic acidosis and stroke like episodes caused by a genetic mutation
CBF
Cerebral Blood Flow.
What is RAWOD and what is its significance?
Regional attenuation without delta. Clinical Significance, Distinctive pattern that indicates a massive and irreversible stroke in ICA/MCA territory
What is the most sensitive neurodiagnostic tool for detecting cerebral ischemia and correlates with its location and degree?
EEG. Detects reversible andirreversible cerebral ischemia
What are the morphology and frequency changesseen in EEG that correlate with CBF level of 35-70mL/100g/min?
Normal EEG, no neuronal injury
What are the morphology and frequency changes seen in EEG that correlate with CBF level of 25-35mL/100g/min?
loss of fast beta frequencies in EEG. Reversible neuronal injury
What are the morphology and frequency changes seen in EEG that correlate with CBF level of 18-25mL/100g/min?
slowing background to 5-7Hztheta in the EEG. Potentially reversible neuronal injury
What are the morphology and frequency changes seen in EEG that correlate with CBF level of 12-18mL/100g/min?
Slowing of background to 1-4Hz delta in EEG. Potentially reversible neuronal injury
What are the morphology and frequency changes seen in EEG that correlate with CBF level of <8-10mL/100g/min?
-Suppression of all frequencies in EEG. Neuronal death
