Module 2

Question 1

Spinal cord injury

Answer 1

Results in loss of motor sensory and autonomic function below level of injury

Question 2

Primary SCI

Answer 2

mechanical disruption to the cord that occurs at the time of injury

Question 3

Secondary SCI

Answer 3

The progressive pathological response that occurs several hours after the injury

hypoxia and hypoperfusion exacerbate secondary SCI

Question 4

Airway management of SCI

Answer 4

maintain Cspine- jaw thrust
SCI are highly sensitive to vagal stimulation because of loss of sympathetic outflow

Monitor for bradycardia

Question 5

At what SCI level and above is resp impacted

Answer 5

T6

Question 6

Neurogenic shock clinical manifestations

Answer 6

Bradycardia
Hypotension
Poikilothermia

Question 7

Spinal shock

Answer 7

Lack of perfusion to spinal cord caused by inflammation
causes a temporary loss of muscle tone and impression of reflex of activity below level of SCI

Injury at any level

No hemodynamic changes

Starts immediately after injury and lasts up to a couple weeks

Question 8

Goal of treatment for SCI

Answer 8

Goal is to limit secondary injury
limit through maintaining optimal cord oxygenation and tissue perfusion
(keep sBP 90-100)
(HR 60-100)
(temp 36.5-37.5)
urine output >30cc/hr

Question 9

SCI interventions

Answer 9

Vasopressors (keep sBP 90-100)
-Phenyl
-Norepi
Atropine (HR 60-100)
monitor core body temperature (36.5-37.5)
monitor urine output
decompression
steroids
limit secondary injury

Question 10

Orthopedic trauma

Answer 10

severe injury to bones, joints or soft tissues

Question 11

compartment syndrome signs and symptoms

Answer 11

Pain
Pulselessness
Pallor
Paraesthesia
Paralysis
Pressure
Poikilothermia

Question 12

compartment syndrome treatment

Answer 12

Fasciotomy

Question 13

Complications from ortho trauma

Answer 13

Fat embolism
Hypovolemic shock
Compartment syndrome

Question 14

Fat embolism symptoms

Answer 14

Resp dysfunction
Neuro changes
peticial Rash

Question 15

Fat embolism

Answer 15

usually from long bone fracture
happens 24-48h post-trauma
inhibits vascular perfusion

Question 16

Interventions for TBI

Answer 16

Airway support
Oxygenation
Hemodynamic support

Question 17

Munros kelly hypothesis

Answer 17

3 things in brain

• CSF
• Blood
• Brain

To compensate for an increase in one we need a decrease in teh other 2
Leads to a blood and css being shunted down spinal cord

Question 18

CBF

Answer 18

cerebral blood flow

Brain does not store O2 or nutrients so it needs a continual supply

Question 19

CPP

Answer 19

cerebral perfusion pressure

The pressure that is needed to maintain blood flow across brain

Question 20

Autoregulation in the brain

Answer 20

The brain dilates and constricts blood vessels in the brain to perfuse and not have a huge flex with increases and decreases in blood pressure

Question 21

Hydrogen and carbon dioxide

Answer 21

potent vasodilator

Question 22

Autonomic nervous system

Answer 22

sympathetic system- activity

parasympathetic system- rest and digest

Question 23

Neurogenic shock

Answer 23

T6 or above
unopposed parasympathetic response
Brady
Hypotension- decreased preload -- decreased cardiac output poor perfusion
Pokiothermia

Question 24

Brain death

Answer 24

GCS <5
Injury to brain
Ventilated
End of life considerations

Question 25

Neurological Determination of Death (NDD)

Answer 25

Established Etiology: Imaging showing

Deep Unresponsive Coma: no motor responses

Apnea test

Ancillary Tests

Absence of:

1. Unresuscitated shock
2. Hypothermia (core temperature <34 degrees Celsius)
3. Severe metabolic disorders capable of causing a potentially reversible coma.
4. Peripheral nerve or muscle dysfunction or neuromuscular blockade potentially accounting for unresponsiveness,
5. Clinically significant drug intoxications (e.g. alcohol, barbiturates, sedatives).

Question 26

Apnea test

Answer 26

Optimal performance requires a period of preoxygenation followed by 100% O2 delivered via the trachea upon disconnection from mechanical ventilation (8-10 mins). The certifying physician must continuously observe the patient for respiratory effort.

Question 27

Ancillary Tests

Answer 27

Demonstration of the global absence of intracranial blood flow is considered the standard for determination of death

Question 28

Established Etiology:

Answer 28

Absence of clinical neurological function with a known, proximate cause that is irreversible.

There must be definite clinical and/or neuroimaging evidence of an acute central nervous system (CNS) event that is consistent with the irreversible loss of neurological function.

Question 29

Preventing secondary injury

Answer 29

Keep hemodynamically stable

Don’t increase ICP

Question 30

gradually increasing confusion, a type of bleed she could have …

Answer 30

chronic subdural hematoma.