NCMB 418 (CU 11 PART 1 and 2) Flashcards
pressure ≥20 mmHg
Increased Intracranial pressure
A dynamic scare that reflects the pressure of cerebrospinal (CSF) within the skull
Increased Intracranial pressure
The ability of the brain to tolerate increases in intracranial volume without adversely increasing
ICP (Monro-Kellie Hypothesis)
Intracranial compliance
The ability of the brain to tolerate and compensate for an increase in intracranial volume through
distention or displacement
Intracranial elastance
a pressure gradient across the brain and is the difference between the arterial blood
entering and the return of venous blood exiting the neurovascular system.
CPP
formula for CPP
MAP – ICP
formula for MAP
systolic BP + 2x diastolic BP / 3
Purposes of ICP and CPP Monitoring:
- To diagnose increased ICP
- Enable interventions
- Provide a tool for predicting the level of injury and patient outcome.
Head injury is injury to the scalp, skull, or brain
TRAUMATIC BRAIN INJURY
- initial damage to the brain that results from the traumatic event.
- may include contusions,
lacerations, torn blood
vessels from impact, acceleration/
deceleration, or foreign
object penetration
Primary injury
evolves over the ensuing hours and days after the initial injury and is due primarily to brain swelling or ongoing bleeding
Secondary injury
most important consideration in any head injury
Brain Injury
If the frontal lobe is affected =
If temporal lobe is affected =
= bizarre irrational behavior
= temporary amnesia or disorientation
- Temporary loss of neurologic function with no apparent structural damage
- Generally involves a period of unconsciousness lasting from a few seconds to a few minutes.
Concussion
A more severe injury; brain is bruised with possible surface hemorrhage
Contusion
Vital signs: BP & temperature – subnormal (somewhat similar to that of shock
Contusion
Hematomas (collections of blood) that develop within the cranial vault
Intracranial Hemorrhage
blood collecting in the epidural (extradural) space between the skull and the dura
Epidural Hematoma
collection of blood between the dura and the brain (space is normally
occupied by a thin cushion of fluid)
Subdural Hematoma
Increased ICP MGT:
- Maintain adequate oxygenation, elevate the head of the bed, maintain normal blood volume
- Devices to monitor ICP or drain CSF
a sudden, abnormal, excessive discharge of electrical activity within the brain that disrupts
the brain’s usual system for nerve conduction
Seizure
definitive test to diagnose seizure activity
Electroencephalography (EEG)
scan of choice for a diagnostic evaluation of certain types of CNS disorders
SPECT scan
a seizure that lasts
longer than 5 minutes, or more than 1 seizure within a 5-minute period, without returning to normal
level of consciousness between episodes
Status Epilepticus
medication for status epilepticus
- Lorazepam (Ativan) – induces respiratory depression
- Flumazenil (Romazicon) – decrease respiratory depression
- Phenytoin via central venous line
- Phenobarbital (Luminal)
causes of status epilepticus
stroke
low blood glucose levels
excessive alcohol
withdrawal symptoms
is the first line and initial treatment for bacterial meningitis
Rifampin (Rifadin)
– an inflammation of the membranes covering the brain and spinal cord
Meningitis
vaccine for meningitis
- hib
- mcv4
Damage to any part of the
spinal cord or nerves at
the end of the spinal
canal
SPINAL CORD INJURY (SCI)
Emergency signs and symptoms
- impaired breathing
- twisted neck/back
- extreme back pain
- weakness
- numbness
- loss of bladder control
- diff. with balance
The brain cannot store oxygen or glucose and
therefore requires a constant flow of blood to
supply these nutrients.
ACUTE ISCHEMIC STROKE
Accounts for approximately
85% of all strokes
Transient Ischemic Attack (TIA)
- refers to the occlusion of a cerebral vessel
- blood clot, infectious particles, fat, air, or tumor
fragments
Embolism
Causes of Ischemic Attack
Embolism and Thrombus
most common cause of ischemic stroke
atherosclerosis
develop during periods of sleep or inactivity
Thrombotic strokes
result in smaller areas of
neuronal cell death)
Lacunar infarct
- an area of tissue surrounding the core
ischemic area. - receives some blood flow from adjacent
vessels but perfusion is marginal - If CBF is improved, this may
recover.
Penumbra
- an excellent tool for detecting intracranial bleeding
- evidence of ischemia may not appear or may be very subtle on standard
CT scanning until 12 to 24 hours after symptom onset
Non-contrast head CT scan
can detect areas of ischemia before they are apparent on CT
Specialized MRI scans
detects areas of vascular
abnormality
MRA
goals of treatment for acute ischemic stroke
- restore circulation to the brain
- stop the ongoing ischemic process
- prevent secondary complications
may cause stroke-like symptoms
hypoglycemia
Administered in an attempt to restore perfusion to the affected area
Fibrinolytic Therapy
Vital signs and neurologic checks
every 15 minutes for the first2 hours, then every 30 minutes for 6 hours, and then hourly until 24 hours following initial treatment
gcs: eye opening
4 - spontaneous
3 - to sound
2 - to pressure
1 - none
gcs: verbal response
5 - oriented
4 - confused
3 - words
2 - sounds
1 - none
gcs: motor response
6 - obey commands
5 - localising
4 - normal flexion
3 - abnormal flexion
2 - extension
1 - none
14-15:
11-13:
9-10:
7-8:
5-6:
3-4:
14-15: ALERT
11-13: Drowsy
9-10: Very drowsy
7-8: Stupor
5-6: Coma
3-4: Deep Coma
