Day 7 - Exam Questions Flashcards
TBI what is the site of diffuse axonal injuries
- Corpus callosum
- Central white matter
- Midbrain
Ref: Cuccurollo
Corpus callosum – cognitive dysfunction.
Cerebral peduncles – hemiparesis or tetraparesis.
Grey white matter junction – slow processing.
Cerebellar peduncles – ataxia dysmetria and nystagmus and motor impairment.
Brainstem (midbrain) – alteration in level of consciousness.
Ref: Flash Cards
You’ve asked to transfer agitated patient. Do you accept him? Why?
We can’t accept the patient
- May harm himself
- May deteriorate
- Will not benefit from rehabilitation at the current state.
List 5 nonpharmacologic approaches may help decrease agitation.
- Avoid overstimulation (e.g., crowded rooms, or television)
- Having a family member stay with him can be helpful.
- If he is at risk of falling, a sitter may reduce that risk
- Restraints should be avoided, as these can both increase agitation and also be risk factors for more serious injury.
- Provide day/night cues, orientation cues, and quiet at night.
- Minimize invasive devices such as IVs or Foley catheters as much as possible.
List 5 pharmacologic approaches may help decrease agitation.
List 5 pharmacologic approaches may help decrease agitation.
Benzodiazepine
Midazolam (IV)
1 to 2.5 mg slow IV every 2 minutes as necessary for sedation
Lorazepam (Orally)
2 to 3 mg BID max of 10 mg/day.
Atypical Antipsychotic
Risperidone (Risperdal)
Maintenance dose: 2 to 8 mg orally per day
Maximum dose: 16 mg orally per day
Quetiapine (Seroquel)
400-800 mg/day starting at 25-50 mg BID and build up.
Typical Antipsychotic
Haldol (haloperidol)
Prompt control acute agitation: 2 to 5 mg IM every 4 to 8 hours
Moderate symptomology: 0.5 to 2 mg orally 2 to 3 times a day
Severe symptomology: 3 to 5 mg orally 2 to 3 times a day
Beta Blocker
Propranolol
10-80mg daily
Antidepressant
SSRI Fluoxetine (Prozac)
Maintenance dose: 20 to 60 mg orally per day
Maximum dose: 80 mg orally per day
List 5 pharmacologic approaches may help decrease agitation.
Benzodiazepine
Midazolam (IV)
1 to 2.5 mg slow IV every 2 minutes as necessary for sedation
Lorazepam (Orally)
2 to 3 mg BID max of 10 mg/day.
Atypical Antipsychotic
Risperidone (Risperdal)
Maintenance dose: 2 to 8 mg orally per day
Maximum dose: 16 mg orally per day
Quetiapine (Seroquel)
400-800 mg/day starting at 25-50 mg BID and build up.
Typical Antipsychotic
Haldol (haloperidol)
Prompt control acute agitation: 2 to 5 mg IM every 4 to 8 hours
Moderate symptomology: 0.5 to 2 mg orally 2 to 3 times a day
Severe symptomology: 3 to 5 mg orally 2 to 3 times a day
Beta Blocker
Propranolol
10-80mg daily
Antidepressant
SSRI Fluoxetine (Prozac)
Maintenance dose: 20 to 60 mg orally per day
Maximum dose: 80 mg orally per day
Environmental Management of Posttraumatic Agitation (Bonus Question)
What classes of medications could be considered to control agitated behavior and what side effects should be considered for each class? 4 marks
💡 Agitated = Psychosis, Tension,
Medications should be used only when conservative measures are failing and the patient is at risk of injuring himself or others. Some medications and possible side:
- Antipsychotics (sedation, slowing of motor recovery, QT interval prolongation, epileptogenic),
- beta-blockers (hypotension, sedation),
- antiseizure medications (hepatotoxicity, sedation),
- Lithium (renal problems),
- Serotonergic medications (electrolyte abnormalities, serotonin syndrome, and priapism).
List 8 signs and symptoms of delirium
Reduced awareness of the environment
- Inability to stay focused on a topic or to switch topics
- Easily distracted by unimportant things
Poor thinking skills (cognitive impairment)
- Poor memory, particularly of recent events
- Disorientation
- Rambling or nonsense speech
Behavior changes
- Restlessness, agitation or combative behavior
- Reversal of night-day sleep-wake cycle
- Seeing things that don’t exist (hallucinations)
- Calling out, moaning or making other sounds
Emotional disturbances
- Anxiety, fear or paranoia
- Depression
- Irritability or anger
- A sense of feeling elated (euphoria)
- Personality changes
Neurology Secrets Chapter 29
What are the potentially life-threatening causes of delirium ? (Bonus Question)
List 4 hormones needed to screen after TBI.
- ACTH deficiency (adrenal insufficiency)
- ADH deficiency (diabetes insipidus)
- IGF-1 (growth hormone deficiency)
- TSH deficiency (secondary hypothyroidism)
- Gonadotropin: FSH, LH, Test or Estrogen (as indicated)
TBI Arousal medication
Amantadine
100 mg orally twice a day
Maximum dose: 400 mg/day
Methylphenidate
20 to 30 mg orally in 2 or 3 divided doses, preferably 30 to 45 minutes before meals
Maximum dose: 60 mg/day
SIADH treatment
- Fluid restriction
- Loop diuretics
- Hypertonic saline
- Vasopressin receptor antagonists
