Critical Care/ICU Monitoring

Question 1

What are five indications for critical care continuous EEG?

Answer 1

-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

Question 2

Once an ICU/critical patient is properly set up for continuous EEG, what do ACNS guidelines recommend that the technologist should do next?

Answer 2

remain at bedside for first20 minutes, evaluate EEG patterns requiring urgent interp, examine behavior, ensure acceptable data quality, perform activations/test reactivity

Question 3

· What things should be checked by the technologist daily for critical care continuous EEG recording?

Answer 3

technical artifacts (at least 2x daily), impedance, electrode stability, patients skin for breakdown, asses reactivity

Question 4

How often should a patient’s skin be assessed in critical care EEG?

Answer 4

daily with written protocols on how and when to check and document

Question 5

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

Answer 5

IRDA, HVAD, triphasic, spindle coma, alpha coma, burst-suppression, ECI

Question 6

How often should a cEEG be reviewed by a qualified enchepalographer for important events?

Answer 6

at least twice a day

Question 7

The preferred term for referring to seizures without prominent motor activity

Answer 7

Nonconvulsive

Question 8

DCI

Answer 8

Delayed Cerebral Ischemia, clinical deterioration and/or cerebral infarction due to vasospasm after SAH. Usually causes wide spread EEG changes

Question 9

ECMO

Answer 9

Extracorporeal membraneoxygenation. Requires ligation of the right common carotid artery and right jugularvein

Question 10

GCS

Answer 10

Glascow Coma scale classifies the severity of TBI

Question 11

Whatare four EEG features that are considered favorable prognostic features?

Answer 11

background continuity, spontaneous variability, reactivity to stimulation, presence of normal sleep patterns

Question 12

HIE

Answer 12

Hypoxic-ischemic encephalopathy, major cause of morbidity and mortality among term newborns

Question 13

ICH

Answer 13

Intracranial hemorrhage

Question 14

Nonconvulsive Seizure (NCS)

Answer 14

far more common than convulsive seizures in children

Question 15

Electrographic Status Epilepticus (ESE)

Answer 15

electrographic seizure for>/ 10 continuous minutes or for a total duration of >/20% of any60-minute period of recording

Question 16

BIRDs

Answer 16

Brief potentially ictal rhythmic discharges. >4 Hz in frequency and >/ 0.5 to <10seconds induration

Question 17

SAH

Answer 17

Subarachnoid Hemorrhage

Question 18

TBI

Answer 18

Traumatic Brain Injury

Question 19

Therapeutic Hypothermia (TH)

Answer 19

associated with improved survival in comatose adults after cardiac arrest

Question 20

SIRPIDs

Answer 20

Stimulus-induced rhythmic,periodic, or ictal-appearing discharges

Question 21

What EEG findings are seen in intraventricular and subarachnoid hemorrhage?

Answer 21

Diffuse slowing and generalized, frontally predominant rhythmic delta (formerly FIRDA)

Question 22

Rasmussen’s Encephalitis

Answer 22

Rare inflammatory neurological disease, mostly children and young adults, typically affects one hemisphere, pharmaco resistant epilepsy, progressive loss of motor/speech skills and hemiparesis with uni-hemispheric brain atrophy

Question 23

Alpha coma

Answer 23

8-13Hz, mostly frontal areas. Caused by intoxications, brainstem lesions and hypoxic-ischemic encephalopathy

Question 24

Beta coma

Answer 24

generalized 12-16Hzbackground activity, maximally frontal regions. Intoxication or withdrawal and severe hyperthyroidism, and brain lesions

Question 25

Spindle Coma

Answer 25

predominant theta and delta background activity w/ super imposed, frequent, paroxysmal spindle-shaped bursts. TBI, ICH, intoxication, post-ictal states, hypoxic-ischemic encephalopathy

Question 26

MELAS

Answer 26

Mitochondrialencephalopathy, lactic acidosis and stroke like episodes caused by a genetic mutation

Question 27

CBF

Answer 27

Cerebral Blood Flow. Normal CBF is 50-70 mL/100g/min

Question 28

What is RAWOD and what is its significance?

Answer 28

Regional attenuation without delta. Clinical Significance, Distinctive pattern that indicates a massive and irreversible stroke in ICA/MCA territory

Question 29

What is the most sensitive neurodiagnostic tool for detecting cerebral ischemia and correlates with its location and degree?

Answer 29

EEG. Detects reversible andirreversible cerebral ischemia

Question 30

What are the morphology and frequency changesseen in EEG that correlate with CBF level of 35-70mL/100g/min?

Answer 30

Normal EEG, no neuronal injury

Question 31

What are the morphology and frequency changes seen in EEG that correlate with CBF level of 25-35mL/100g/min?

Answer 31

loss of fast beta frequencies in EEG. Reversible neuronal injury

Question 32

What are the morphology and frequency changes seen in EEG that correlate with CBF level of 18-25mL/100g/min?

Answer 32

slowing background to 5-7Hztheta in the EEG. Potentially reversible neuronal injury

Question 33

What are the morphology and frequency changes seen in EEG that correlate with CBF level of 12-18mL/100g/min?

Answer 33

Slowing of background to 1-4Hz delta in EEG. Potentially reversible neuronal injury

Question 34

What are the morphology and frequency changes seen in EEG that correlate with CBF level of <8-10mL/100g/min?

Answer 34

-Suppression of all frequencies in EEG. Neuronal death