Final Blueprint Neuro

Question 1

SCI injury severity?

Answer 1

Complications lead to emergency and life threatening problems

Neurogenic shock: any factor that stimulates parasympathetic activity or inhibits sympathetic activity of vascular Smoot muscles can cause neurogenic shock, which results in widespread and massive vasodilation.

Causes: spinal cord injury above T5, spinal anesthesia, and vasomotor center depression (severe pain, drugs, hypoglycomia)

Symptoms: low systemic vascular resistance, excessive parasympathetic activity, and bradycardia

The 2 biggest problems that arise = hypotension and bradycardia

Question 2

what are the types of spinal injuries?

Answer 2

Cervical injury (C1-C8) = effects all 4 limbs and impaired breathing

Thoracic injury (T1-T12) = effects lower limbs (Paraplegia) and legs, bladder, bowels

Lumbar injury (L1-L5) = effects legs and bladder

Question 3

what is important to know about spinal shock?

Answer 3

Loss of reflexes
Loss of motor control
Low BP
Decreased HR
Flaccid paralysis
Urinary retention
Fecal incontinence
Spasms/ increased muscle tone

Question 4

what is neurogenic shock?

Answer 4

Disconnect between SNS and PNS causes the PNS to slow everything down w/o the SNS to balance

Bradycardia is unique to this bc of the dissociation

Skin is warm, pink, dry due to pooling of blood from massive vasodilation

Hemodynamic phenomenon: loss of vasomotor tone and loss of sympathetic nervous system tone > impaired cellular metabolism

Critical features:
-Hypotension: due to massive vasodilation
-Bradycardia: due to unopposed parasympathetic stimulation
-Poikilothermia: unable to regulate temperature

Occurs: within 30 M cord injury level T5 or above; last up to 6 weeks; also due to effect some drugs that effect vasomotor center of medulla as opioids, benzodiazepines

Management (determine underlying cause):
-Airway support
-Fluids PRN: typically o.9 NS, rate depends upon need
-Atropine for Bradycardia
-Vasopressor as phenylephrine (neosynephrine for BP support)

Question 5

what is an open TBI?

Answer 5

Basilar skull fracture (visible of the external skull)

Key finding: clear of blood-tinged drainage from the eyes, ears, nose that is positive for glucose = CSF

Question 6

what is a closed TBI?

Answer 6

Concussion (CM: brief LOC, headache, retrograde amnesia (memory loss of events immediately prior to injury)

Contusion (more emergent; described as: coup, countercoup, and together)

Question 7

affecting 1 area of the brain due to impact

Answer 7

coup

Question 8

affecting the area opposite of coup

Answer 8

countercoup

Question 9

typically affecting the frontal and occipital lobes; together

Answer 9

coup-countercoup

Question 10

early increased ICP signs?

Answer 10

Agitation
restless/ irritability
Change in LOC
Decreased mental status
Sudden vomiting w/o nausea

Question 11

late increased ICP signs?

Answer 11

Seizures
Posturing (decorticate and decerebrate)
Cushing’s triad

Question 12

what are the late deadly signs of increased ICP?

Answer 12

Lungs: irregular respirations and Cheyne strokes respirations

Neck: nuchal rigidity (stiff neck)

Brain stem affected:
Eyes: pupils “fixed and dilated” unequal and 8mm (normal = 2-6 mm)
Foot: babinski reflex and toes fan out when stimulated = BAD

Seizures and coma
Abnormal posturing: decorticate and decerebrate

Question 13

what is the management of a CVA?

Answer 13

Goal for treating an embolic stroke with tPA are time oriented. Best practice is to start tPA within 4 H of last known well time and within 60 minutes of arrival at treatment center.

neuro assessment Q1-2H (NIH stroke scale), VS including ICP, CPP Q1-2H and PRN, resp status, I&O, fluid balance, IV fluids, ECG and cardiac enzymes, serum electrolytes especially Na+, bladder and bowel function, and ability to communicate.

Question 14

what does “BE FAST” stand for?

Answer 14

Be Fast = Balance (headache & dizzy), eyes (sudden loss of vision in one of both eyes), face (does the pts face look uneven?, arm (weak), speech (difficulty), and time (call 911).

Question 15

What are the changes in GCS/priorities?

Answer 15

Behavior = eyes opening, verbal response, and motor response

Response = eyes (1-4 grade), verbal (1-5 grade), and motor (1-6 grade)

Eyes opening = 4 (open spontaneously), 3 (open to speech), 2 (open to pain), 1 (no eye opening)

Verbal response = 5 (oriented to time, person, place), 4 (confused), 3 (inappropriate words), 2 (incomprehensible sounds), 1 (no verbal response)

Motor response = 6 (obey commands), 5 (moves to localized pain), 4 (withdrawal from pain), 3 (abnormal flexion), 2 (abnormal extension), 1 (no motor response)

13-15 mild
9-12 moderate
3-8 severe
Less than 8 = intubate