Exam 1 Flashcards
4 lobes of the cerebrum and their functions
- Frontal
- speech, thinking, voluntary muscle movement, personality
- Temporal
- sounds
- Wernicke’s area
- Parietal
- Functions related to speech
- body positioning
- Occipital
- Sight
Temporal lobe epilepsy
- “Partial epilepsy”
- Odd feelings, such as euphoria, deja vu, fear
- Focal impaired awareness seizure
Parietal lobe seizure
- sensory disturbances, such as heat, numbness or electrical sensations, weakness, dizziness, hallucinations, distortions of space and other symptoms.
- Very uncommon
- Difficult to diagnose, subjective
Phases of capnography
- Phase I – Beginning of exhalation, air from dead space being exhaled w/small to no present CO2.
- Phase II- CO2 from larger bronchioles resulting in upslope
- Phase III- Alveolar plateau and end tidal CO2
- Phase 0 - inhalation
Generalized epileptic seizures
- Grand mal
- Both brain hemispheres origin
- Motor and Non Motor (abesnce) seizures
- Tonic (stiffening) Clonic (jerking)
- Types
- Absence
- Atonic
- Myoclonic
- Tonic-clonic
Focal epileptic seizure
- Partial seizure
- Begins in one hemisphere
- Types
- Focal aware
- Focal impaired awareness seizure (complex partial)
Motor Onset Seizure
- Change in muscle activity
- One or both sides of body
- Non- motor onset affect senses
VITAMIN acronym
For seizures:
- Vascular
- strokes, embolis stroke
- Infections
- Meningitis, encephalitis, cerebral malaria
- Trauma
- Head injuries
- AV Malfunction
- cavernous malformations
- Metabolic
- Hypoglycemic, hypoxic, hyponatremia
- Idiopathic
- Unknown cause
- Neoplasms
- Primary or Secondary
- OTHERS
- Sleep deprivation, drug overdose, fever, eclampsia, hydrocephalus, multiple sclerosis
Syncope vs Seizure
- Syncope is a complete LOC
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AEIOU-TIPS for altered mental status
- Alcohol/Acidosis
- Epilepsy/Endocrine/Electrolytes
- Infection
- Opiates, Overdose
- Uremia/Underdose
- Trauma
- Insulin
- Poisoning/Psychosis
- Stroke/Seizure/Syncope
Causes of Seizures
- Abnormal levels of sodium/glucose
- Brain infection, meningitis, encephalitis
- Brain tumor
- Drug abuse
- Eclampsia
- Epilepsy
- Fever
- Head injury
- Heart disease
- Poisoning
- Street drugs (PCP, cocaine, amphetamines)
- Stroke
- Very high BP
- Withdrawal from ETOH, some meds
Partial seizures
- Involve only part of the brain
- 2 types
- Simple = no LOC
- sensory/other changes
- Complex = LOC to varying degrees
- Simple = no LOC
Generalized seizure
- Whole brain/both hemisphere involvement
- 4 types
- Absence (Petit Mal)
- Vacant, unresponsive for a short time (30 seconds usually)
- Slight muscle twitching
- Several times a day sometimes
- Common in children
- Myoclonic
- Extremely brief (<1 second)
- Jerky movements, contractions.
- Clonic
- Myoclonic that repeat at a rate of 2-3 per second, varies
- Tonic clonic (Grand mal)
- Tonic phase = initial contraction of muscles
- May involve absence of breathing.
- Clonic phase
- Rhythmic muscle contractions that follow
- Tonic phase = initial contraction of muscles
- Atonic
- Loss of muscle tone, fall to ground
- “drop attacks”
- Is NOT Cataplexy (looks very similar)
- Absence (Petit Mal)
Methylprednisone Sodium (Solumedrol)
Class:
- Steroid
Action:
- Decreases the inflammatory response
Indications/Dose
- Refractory
- Obstructive SOB
- Allergic Reaction/Anaphalyxis
- 125mg SIVP
Contraindications
- None
Side Effects
- None
Diazepam (Valium)
Class: Benzodiazepine
Action: Increases GABA effects, Raises seizure threshold in CNS, Causes amnesia
Indications: Seizures, Procedures, Extreme Anxiety
Dose: 2-10mg SIVP (every 10-15 min PRN) Max: 30mg
Contraindications: Respiratory depression
Side Effects:
- Respiratory depression
- Hypotension
- Ataxia
- Confusion
- Psychomotor impairment
Albuterol (Proventil)
Class: Sympathomimetic, Selective Beta 2 agonist
Action:
- Relaxes smooth muscle
- Bronchodilation
- Relieves bronchospasms
- Reduces airway resistance
Indications: Respiratory distress with bronchospasms (Asthma/COPD/Allergic Reaction/Pneumonia)
Dose: 2.5mg in 3mL SVN, repeat as needed
Contraindications: MI, pulmonary edema
Side Effects:
- Anxiety
- dizziness
- tachycardia
- dysrhythmias
Atrovent (Ipratropium Bromide)
Class: Anticholinergic
Action: Blocks acetylcholine at bronchial receptor sites (Bronchodilates)
Indications: Obstructed SOB (Asthma/COPD/Allergic/Pneumonia)
Dose: 0.5mg in 2.5mL SVN, repeat 30-45min
Contraindications:
- MI/Angina
- Cardiac Pulmonary edema
- Glaucoma
Side Effects:
- Tachycardia
- Anxiety
- Anticholinergic toxidrome (Mad/hot/red/dry/blind)
Aspiration
Inhalation of foreign contents into lungs
Cerebral Perfusion Pressure
CPP
The difference between MAP and ICP
CPP = MAP - ICP
Capnometry
numeric and graphical representation of CO2 concentration exhaled in each breath
Pulsus Paradoxus
HR elevates, Systolic BP drops on inhalation
Cor Pulmonale
Right ventricular hypertrophy (Right sided heart failure) due to emphysema
Antigen
A toxin/foreign substance which induces an immune response in the body
Cushings triad
Wide PP, Increase BP, decrease HR, irregular respirations
Hypoxemia
Low O2 in the blood
Syncope
Temporary loss of consciousness
Mast cells
Specialized cells that bind to an antibody to release histamine
List 3 causes of SOB besides COPD
MI
PE
Pneumonia
Pneumothorax
Anaphalyxis
Breathing patterns
What can be the first sign of altered mentation?
Anxiety
What is the primary respiratory drive in a normal healthy person?
CO2
What is amyotrophic lateral sclerosis?
Progressive degeneration of muscle specific nerve cell breakdown. Also called Lou Gehrigs Disease
Wernicke-Korsakoff syndrome
Reduction in intestional absorption and metabolism of thiamine.
Wernicke Encephalopathy
- Usually chronic alcoholics
- Acute neurological condition caused by thiamine deficiency
- Presents with ophthalmoparesis (weakness/paralysis of eye)
- Nystagmus
- ataxia
- confusion
- Need Vitamin B1, glucose, fluid.
- LIFE THREATENING ILLNESS
Korsakoff syndrome
- Memory/mental disorder
- Severe B1 deficiency
- SLOW onset
What does Vitamin B1 do?
- Helps brain produce energy from sugar
- Without it, brain cannot generate energy to function properly
- Mostly alcoholics need it but defeciency can come from AIDS, Cancers, infections, poor nutrition.
Oxy Hemoglobin Dissociation Curve (photo)
Oxy hemoglobin dissociation curve: what happens as temperature increases?
- Increases
- pH decreases, need more O2 to get a good pulse ox.
- O2 affinity lower to hemoglobin
- Lets oxygen go when in hot working muscles for fast use
- Hotter = O2 doesn’t retain on hemoglobin as well
Oxy hemoglobin dissociation curve: what happens when temperature decreases?
- pH increases
- need less O2 for good pulse ox, higher affinity for O2.
- O2 delivery to tissues is bad, won’t let go of O2.
- moves curve to left
Bohr effect
- Shifts to the right
- High affinity for O2, assists with perfusion at tissues
Haldane effect
- Shifts left
- Helps dissociate CO2 to be released at the lungs
What do shark waves in capnography mean?
- Prolongation of the expiratory phase 3 (bronchoconstriction like emphysema)
- Angle between 2 and 3 is lost, resulting in fin shape
- Constant increase in the amount of exhaled CO2
Pathophysiology of allergic reaction/anaphalyxis
- Antigen (allergen) enters body
- B cells release IgE antibodies
- IgE bind to mast cells to create rapid response for next allergen exposure
- Allergen enters the body again later
- Allergen combines with IgE on Mast cells triggering release of histamine from mast cells
- Histamine stimulates vasodilation causing fluid leak, mucus production, and bronchoconstriction
- BP drops and widens. Will be tachycardic
- S/S: Upper airway swelling, stridor, wheezes, dyspnea, edema, hives/rash, chest tightness, anxiety
Emphysema pathophysiology
-
Emphysema (Pink Puffer)
- Thin, barrel chest presentation
- Nonproductive cough
- Wheezing and Rhonchi
- Pink Complexion
- Extreme dyspnea on exertion
- Prolonged expiration (pursed-lip breathing)
Bronchitis pathophysiology
-
Bronchitis (Blue Bloater)
- Typically overweight in chronic patients
- Productive cough with sputum
- Coarse rhonchi
- Cyanosis
- Mild dyspnea
- Resistance on inspiration and expiration
Chronic Bronchitis pathophysiology ALS level
- Overproduction of mucus in the lungs
- Caused by irritants in lungs like smoke
- Lungs irritated and produce mucus to get rid of irritants
- Over growth of mucus glands – permanent tissue change due to continuous production of mucus. Body makes more glands to get rid of more irritants
Emphysema ALS level
- Loss of lung elasticity, enlargement of air spaces distal to small bronchioles, destruction of alveolar walls
- Air trapping. Expiration extended, increased residual volume
- Elastase breaks down elastin due to smoking
- Chronic hypoxia due to polyscythemia side effect, low SPO2
- CO2 elevates, respiratory acidosis with compensatory metabolic alkalosis. Now you depend on o2 to breathe instead of CO2
- Cor pulmonale = right ventricular hypertrophy
- impaired left ventricular filling and reduced left ventricular stroke volume and cardiac output. This is due to pulmonary hyperinflation putting pressure/strain on the heart
- Treatment:
- CPAP, IV, 12 lead, albuterol, atrovent, fluid
