EM 6 - Neuro pt1 Flashcards
What med treats cerebral edema (found in stroke)
Mannitol
Most common pathology of ischemic stroke:
atherosclerosis of carotid & vertebrobasilar arteries cardiac abnormalities (a fib)
True or false: you can distinguish ischemic from hemorrhagic stroke based on the patient’s history
false
What is the general assessment of Stroke?
ABCDE
d = deformities (impaired gag reflex, etc)
e = exposure (search for trauma)
Decerebrate posture indicates: Arms: \_\_ & \_\_ at elbow Wrists: \_\_ fingers: \_\_ Legs: \_\_ Feet: \_\_
Damage to upper brain stem Arms: adducted & extended at elbow Wrists: pronated Fingers: flexed Legs: stiffly extended Feet: plantar-flexed
What is this indicative of/called?
Arms: adducted & extended Wrists: pronated Fingers: flexed Legs: stiffly extended Feet: plantar-flexed
Decerebrate posture
Damage to upper brain stem
Decorticate posture indicates: Arms: \_\_ & \_\_ at elbow Wrists: \_\_ fingers: \_\_ Legs: \_\_ & \_\_ Feet: \_\_
Damage to one or both corticospinal tracts
Arms: adducted & flexed at elbow
Wrists: on chest
fingers: on chest
Legs: stiffly extended & internally rotated
Feet: plantar-flexed
What is this indicative of/called?
Arms: adducted & flexed at elbow Wrists: on chest fingers: on chest Legs: stiffly extended & internally rotated Feet: plantar-flexed
Decorticate posture
Damage to one or both corticospinal tracts
Name 2 maneuvers to check if the brainstem is intact following a stroke.
The patient must also be __
- Oculocephalic reflex
- Oculovestibular reflex
the patient must also be comatose.
Describe Oculocephalic reflex
Which CN are tested?
it’s a maneuver to check if brainstem was involved or not w/ stroke.
Open up their eyes, turn their head side to side.
Normally the eyes will move the opposite direction the head is being turned.
CN: 3,4,6 (olfact, trochlear, abducens)
Describe Oculovestibular reflex
Which CN are tested?
What if this was done in a conscious patient?
Instill cold water into an ear
Normally they look in that direction
CN 3,4,6,8 (olfact, trochlear, abducens, vestibulococh)
a conscious patient would have nystagmus to the opposite side.
NIH stroke scale grading system (6)
0: Normal 1-4: Minor 5-15: Moderate 15-20: Moderately severe >20: Severe >42: Devastating
t-pa dosing
0.9 mg/kg.
10% as bolus, 90% continuous infusion over 1 hour.
t-pa must be given within how long?
Unless…
3 hours
Unless stroke is due to occlusion in MIDDLE CEREBRAL artery, then it is 6 hours. (AHA endorsement)
2 types of hemorrhagic stroke (Intracranial hemorrhages)
SAH, Intracerebral hemorrhage
