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Q4 EM Surg > Exam 4 Neuro Trauma: Cerebral > Flashcards

Exam 4 Neuro Trauma: Cerebral Flashcards

1
Q

Closed Head Injury (CHI): Coup v Countercoup?

A

Coup = Injury at sight of impact

Countercoup = Injury at site opposite impact

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2
Q

ICU monitoring of head injury includes? (8)

A 
IVF
Card monitoring
BIS monitoring (brain activity)
Tube feed
Sedation
Vent
Central line
A-line
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3
Q

A-line goes where?

Used for?

Not used for?

A

U radial a

Monitor BP
Get ABG samples

Meds

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4
Q

Central line goes where?

Used for?

A

U int jugular or subclavian

Monitor venous pressure
Fluids/meds

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5
Q

Critical factor of brain fxn is?

A

Cerebral blood flow (CBF)

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6
Q

Cerebral Perfusion Presssure (CPP) is?

A

MAP - ICP

N ≥ 50

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7
Q

ICP normal values: Adult?

Kids?

A

< 15

< 7
1.5 - 6 infants

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8
Q

↑ in ICP leads to?

A

Arterial pressure displacement ->
CPP ↓ ->
Cerebral ischemia

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9
Q

If ICP = MAP, what happens?

A

arterial blood can’t enter skull

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10
Q

Uncal Herniation is?

A

Uncus (inner temporal lobe) pushed into mid-brainstem -> CN III compression

Most C type of herniation
U from trauma

Ipsilat eye turned down/out, pupil dilated
Visual defects

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11
Q

Coma scale for Closed Head Injury:

Mild?

Mod?

Severe?

Brain death?

A

Mild > 13

Mod 9 - 13

Severe < 9

Brain death = 3

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12
Q

Decorticate posturing?

A

Hands to body core,
Plantar flex
Internal rotation of legs

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13
Q

Decerebrate posturing?

A

(Damage to corticospinal tract @ pons/medulla)

Legs same
Arms extended, pronated
Wrists flexed

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14
Q

Exam findings for Basilar Skull Fxr? (4)

A

Racoon eyes
Battle sign
Hemotympanum
CSF rhinorr/otorrhea

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15
Q

Extremity neuro exam rating:

1/5?

2/5?

3/5?

4/5?

5/5?

A

1/5 = Flicker

2/5 = mvmt w/ no gravity

3/5 = mvmt against gravity

4/5 = weakness

5/5 = complete

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16
Q

Reflex neuro exams? (4)

A

DTR
Clonus
Babinski
Hoffman (flick fingernail, other fingers flex)

17
Q

IntraAxial Cerebral Hemorr includes?

A

Intracerebral hemotoma

Diffuse Axonal Injury

18
Q

ExtraAxial Cerebral Hemorr includes? (3)

A

Subarachnoid hemorr
Subdural hemorr
Epidermal hemorr

19
Q

Diffuse Axonal Injury is?

A

IntraAxial Cerebral Hemorr
2nd most C
U multiple lesions

20
Q

SDH presentation:

Age?

Co-morb?

Atrophy?

Caused by?

Which vessels?

CT findings?

Onset?

Tx?

A

Age = Elderly

Co-morb = Coagulopathy

Brain atrophy

Cause = Traumatic or spontaneous (U falls)

In Bridging veins

CT = Crescent along the brain

Acute: sxs w/i 24 hrs
Subacute: sxs 24hrs to 2wks post
Chronic: sxs > 2wks

Craniotomy
Burr hole
Observation

21
Q

EDH presentation:

Age?

Co-morb?

Atrophy?

Caused by?

Which vessels?

CT findings?

Onset?

Tx?

A

Age = young adult

Co-morb = U none

Atrophy = little or no brain atrophy

Caused by = trauma only

Which vessels = U Middle meningeal aa in temporal-parietal area

CT findings = Lenticular (lens) shape attached to dura

Onset = Acute onset, lucid intervals

Tx = Craniotomy, observation, NO burr hole

22
Q

Intracranial HTN:

O2 goal?

BP goal?

Fluids?

Glucose?

Elevate head?

A

PaO2 > 60 or O2 sat > 90%

SBP/MAP > 90

NS + KCl
Avoid LRs and hypotonics

Avoid hypergly (80-180)

30-45° (helps venous outflow, lowers carotid pressure)

23
Q

Intracranial HTN: Coag mgmt

INR?

Platelets?

Hgb?

Central venous pressure?

Reverse coagulopathy w/?

Sedation?

A

Correct INR

Platelets > 75

Hg > 9

CVP 5-7

Coumadin, Plavix

Heavy sedation w/ Fentanyl lowers ICP

24
Q

Mannitol is used for what?

A

IC HTN

Osmotic effect draws edema from brain tissue

25
Q

Most potent means of causing vasodilation in IC HTN?

A

↓ PaCO2 to 30-35 w/ hyperventilation

26
Q

Guillain Barre etiology? (7)

A 
Most C demyelination neuropathy
Viral URI
Immunization
Surgery
C. jejuni
CMV
Mycoplasma
27
Q

Guillain Barre presentation? (7)

A 
Sxs onset days-wks post infection
Symmetrical Ascending paralysis (legs and up)
Progressive mm weakness
Areflexia
U CN involvement
P paresthesia and loss of proprioception
ELEVATED CSF protein w/o pleocytosis
28
Q

Guillain Barre tx? (4)

A

IVIG x 5 days
Plasmapharesis x 5 exchanges
NO steroids
U full recovery @ 1 yr

29
Q

Meningitis caused by: ≤ 3 mo? (3)

A

Strep B
E coli
Listeria

30
Q

Meningitis caused by: kids? (3)

A

Neisseria
Strep pneumo
H flu B

31
Q

Meningitis caused by: adults? (3)

A

Neisseria

Strep pneumo

32
Q

Meningitis presentation? (4)

A

N/V
HA, Photophobia, Confusion
Stiff neck
+ Brudzinski/Kernig

33
Q

Meningitis diagnostics?

A

Lumbar puncture for:
Cx/count
Protein
Glucose

34
Q

Meningitis long term effects? (3)

A

Deaf
Encephalopathy
Seizures

Q4 EM Surg (27 decks)

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