Exam 3 - Cindy's Flashcards
Concussion
Mild brief loss of neurological function
DAI
Prolonged coma caused by coup/countercoup injury
Epidural hematoma (EDH)
ARTERIAL bleeding, bleeding between dura and skull; middle meningeal artery rupture, Brief loss of consciousness, followed, by a lucid period and then deep coma
Craniotomy Care
Post-Op: neuro checks, monitor for IICP, check airway, pain, nutritional status and any CSF leaks
Complications of SAH (subarachnoid hemorrhage)
Vasospasms
Rebleeds
Hydrocephalus
C-1 thru C-4 Cervical spine injury
Assess airway, lose diaphragm use, ventilator dependent
Major complications of spinal cord injuries
DVT / PE
Autonomic dysreflexia
Exaggerated autonomic response t visceral stimulation occurring with injuries above T6.
MEDICAL EMERGENCY
TX/Interventions for Autonomic dysreflexia
Elevate HOB, check for bowel impaction, bladder distenstion, and kinks in foley, evaluate skin for pressure areas. Medicate for HTN using HYPERSTAT, Resperpine or Atropine
Plasmaphresis
Infection, hypovolemia, clotting abnormalities, hypokalemia, hypocalcemia, hypotension, myasthenic and cholinergic crisis
Contusion
Bruising of the Brain
Subdural hematoma (SDH)
VENOUS bleeding, between dura and arachnoid layers; see progressive neuro changes over 2-4 weeks
SIADH
Complication post head injury, see coma, may have lung crackles decreased urine output
Subarachnoid hemorrhage (SAH)
Bleeding into subarachnoid space between pia and achachnoid layers, usually from rupture of Berry aneurysms.
Nimotop (nimodipine)
Prevents vasospasms, give for 21 days
Spinal shock
May last weeks to months, see flaccid paralysis below the level of lesion, lose temp control, see hypotension
Use of steroids in spinal cord injury
Treats secondary injuries, decreases swelling/inflammation of cord
S/S of Autonomic Dysreflexia
Severe HTN HA Bradycardia Flushing of the face/neck pupil dilation
Myasthenia Gravis
Affects neuromuscular transmission of voluntary muscles. See excessive weakness and fatigue of voluntary muscles. Any age, more common in women ages 14-35 and men over 40. Tensilon test will confirm diagnosis
Guillian-Barre syndrome
Rapidly ASCENDING peripheral and cranial nerve dysfunction, leading to paralysis. Respiratory arrest is most common cause of death. check vital capacity and ABGs every shift in assessing respiratory function.
Monroe-Kellie Doctrine
An increase in blood, CSF, or brain tissue is accompanied by a reciprocal change in the volume in one of the others
How to estimate cerebral perfusion pressure. What is normal CPP?
CPP = MAP - ICP
Normal CPP is 60-100 mmHg
Factors that increase ICP
Valsalva, coughing, sneezing, body positions, neck flexion
Cushing’s Triad
Increased systolic pressure with decreased diastolic pressure (widened pulse pressure) and bradycardia
ICP Monitoring
Zero and maintain at Foramen of Monroe (corner of eye) never flush if connected to hemodynamic system
Pharmacological management of ICP
Mannitol, lasix, steroids, barbituates, and anticonvulsants
Assessment of neuro status
Restlessness
Basal skull Fracture s/s
Raccoon’s eyes, battles sign
Kernig’s sign
Cannot extend leg when thigh flexed on abdomen (menningeal irritation)
Posturing
Decorticate: flexion of arms to center
Decerebrate: extension of arms
DKA
Glucose 200-800
Positive serum and urine ketones
Insulin dependent diabetics (TYPE 1)
Acetone smell to breath
HHNS / HHNK
Glucose 800-2000 No ketones Serum osmolarity high Elderly Higher mortality rate
DIC
Overstimulation of normal coagulation mechanisms, leading to microvascular thrombi, consumes all coagulation factors which leads to hemorrhage
Labs in DIC
Platelets decreased
Fibrinogen level decreased
PT/PTT prolonged
Fibrin degradation products (FDP) increased
Shock
hypo perfusion of body tissues
Types of shock
Volume (hemorrhage)
Pump (cardiac)
Vessel (sepsis and anaphylaxis)
MAST
Military anti-shock trousers, used to shunt blood from legs to abdomen and vital organs for perfusion
Burn rule of 9s
head & neck = 9 arm = 9 ea trunk =18 front/ 18 back legs = 18 ea perineum = 1
Calculation of fluid resuscitation for burns
parkland formula 4mL/kg X %BSA burned = fluids for first 24hrs -1st 8hrs = 1/2 total Amt -2nd 8hrs = 1/4 total Amt -3rd 8hrs = 1/4 total Amt
LR is solution of choice
Shock stage of burns
Hypovolemic: fluids shift from vascular to interstitial space, see hemoconcentration and edema. Fluids and electrolytes are lost. HYPERKALEMIA, HYPONATREMIA
Diuretic phase: fluids shift back to vascular space, see hemodilution and diuresis.
Priorities in burn care
-Airway management first, then fluid resuscitation
Cause of myoglobinuria
Skeletal muscle breakdown, increased Ca+ in and destroys muscle fibers. urin is dark rusty brown to black
Extremity management in burns
If circumferential, monitor pulses and venous return, monitor for numbness and pain. An escharotomy may be necessary.
Wound care in burns
Cleansing (hubbard tank) debridement Silvadene (painless) Sulfamylon (painful) Silver nitrate (stains black)
Primary Assessment for Trauma
Airway breathing circulation, control and external hemorrhage, IV, MAST, immobilize potential fractures
Disability, Exposure Fahrenheit, Get full set of vitals, History
Secondary assessment for trauma
More thorough and complete assessment
Intubate, Place on 100% O2, Stabilize fractures
Additional labs and x-rays, possible peritoneal lavage or abdominal scan, OR, ICU, ongoing assessments
Factors that have contributed to success of organ transplantation
Cyclosporine
Surgical techniques
Organ and tissue preservation
Legal definition of brain death
Drugs used to prevent rejection
Cyclosporine, steroids, prograf
