Module 2 Flashcards
Spinal cord injury
Results in loss of motor sensory and autonomic function below level of injury
Primary SCI
mechanical disruption to the cord that occurs at the time of injury
Secondary SCI
The progressive pathological response that occurs several hours after the injury
hypoxia and hypoperfusion exacerbate secondary SCI
Airway management of SCI
maintain Cspine- jaw thrust
SCI are highly sensitive to vagal stimulation because of loss of sympathetic outflow
Monitor for bradycardia
At what SCI level and above is resp impacted
T6
Neurogenic shock clinical manifestations
Bradycardia
Hypotension
Poikilothermia
Spinal shock
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
Goal of treatment for SCI
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
SCI interventions
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
Orthopedic trauma
severe injury to bones, joints or soft tissues
compartment syndrome signs and symptoms
Pain Pulselessness Pallor Paraesthesia Paralysis Pressure Poikilothermia
compartment syndrome treatment
Fasciotomy
Complications from ortho trauma
Fat embolism
Hypovolemic shock
Compartment syndrome
Fat embolism symptoms
Resp dysfunction
Neuro changes
peticial Rash
Fat embolism
usually from long bone fracture
happens 24-48h post-trauma
inhibits vascular perfusion
Interventions for TBI
Airway support
Oxygenation
Hemodynamic support
Munros kelly hypothesis
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
CBF
cerebral blood flow
Brain does not store O2 or nutrients so it needs a continual supply
CPP
cerebral perfusion pressure
The pressure that is needed to maintain blood flow across brain
Autoregulation in the brain
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
Hydrogen and carbon dioxide
potent vasodilator
Autonomic nervous system
sympathetic system- activity
parasympathetic system- rest and digest
Neurogenic shock
T6 or above unopposed parasympathetic response Brady Hypotension- decreased preload -- decreased cardiac output poor perfusion Pokiothermia
Brain death
GCS <5
Injury to brain
Ventilated
End of life considerations
Neurological Determination of Death (NDD)
Established Etiology: Imaging showing
Deep Unresponsive Coma: no motor responses
Apnea test
Ancillary Tests
Absence of:
- Unresuscitated shock
- Hypothermia (core temperature <34 degrees Celsius)
- Severe metabolic disorders capable of causing a potentially reversible coma.
- Peripheral nerve or muscle dysfunction or neuromuscular blockade potentially accounting for unresponsiveness,
- Clinically significant drug intoxications (e.g. alcohol, barbiturates, sedatives).
Apnea test
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.
Ancillary Tests
Demonstration of the global absence of intracranial blood flow is considered the standard for determination of death
Established Etiology:
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.
Preventing secondary injury
Keep hemodynamically stable
Don’t increase ICP
gradually increasing confusion, a type of bleed she could have …
chronic subdural hematoma.
