Lecture 8 - the acute patient - cerebral hemorrhage and tumour

Question 1

Define increase of ICP

Answer 1

increase in volume of blood, brain, CSF will increase ICP

Question 2

what is a normal ICP

Answer 2

<10mmHG

Question 3

If ICP increases to 20mmHG what do you get

Answer 3

vomitting, decreased levels of consciousness

Question 4

If ICP increases to 40mmHG what do you get

Answer 4

herniation through foramen magnum - fatal

Question 5

Clinical signs of raise ICP

Answer 5

headache, vomiting, reduced level of consciousness, increased BP, bradychardia, slow/irregular respiration

Question 6

What type of brain hemorrhage is characterized by blood below the dura and between the dura and arachnoid mata

Answer 6

SDH

Question 7

ICH is bleeding where?

Answer 7

in the brain parenchyma

Question 8

EDH is defined as

Answer 8

blood between the dura and bone

Question 9

SAH is defined as

Answer 9

blood in the subarachnoid space

Question 10

Medical Management for EDH,SDH,SAH,

Answer 10

EDH+SDH - bone flap removed - ensure helmet is worn

SAH - 70% die, Analgesia, bed rest, surgery (clipping/coiling) - if vasospasm present - do not mobilize

Question 11

TBI managment and CIs/Precs

Answer 11

Control ICP - sedate, ventilate, decompression surgery?

CIs/Precs: PTA, WB restrictions, Dysautonomia, PROM

Question 12

what is dysautonomia?

Answer 12

severe paroxysmal increase in HR, RR, BP, and temp + abnormal postures

Question 13

Why is PROM a precaution for a patient with TBI

Answer 13

if performed too vigorously could cause microtears which increase risk of ossifications in muscle

Question 14

What are two types of cerebral tumours and there prognosis

Answer 14

Astrocytoma - 44% and poor long term prognosis

Meningioma - 15% good prognosis

Question 15

What is hydrocephalus and what are its causes

Answer 15

excessive CSF in ventricles of brain - increases ICP

Causes: congential blockage 
trauma
SAH
infection
tumour
aqueduct stenosis

Question 16

what is the importance of the EVD

Answer 16

maintains correct CSF volume in brain

if head is elevated too high relative to drain, too much CSF will drain out - risk of SDH

never move without clamp