Neural/Hormonal Lab Flashcards
Benzodiazepines
- Ativan
- Valium
- Versed
Opiates
- Propofol/diprivan
- Demoral
- Morphine
- Fentanyl
Discharge Criteria for Conscious Sedation
- VS
- Airway patent
- LOC
- Tolerate fluids
- Discharge instructions
- Responsible driver
- Depressed LOC
- Arouse to stimulation
- Protective reflexes intact
conscious/moderate sedation
Indications for focosed neuro assessment:
- • head injury
• stroke
• cranial surgery
• drug/alcohol overdose
• metabolic disorders (renal, electrolyte)
is the most important assessment for neuro pts; changes are earliest indicator of neuro compromise
Level of Conscious (LOC)
Eye opening in response to voice or painful stimulus
Spontaneous (4) = opens eyes without any stimulus
To sound (3) = only opens eyes in response to voice stimulus
To pain (2) = only opens eyes in response to painful stimulus
Never (1) = never opens eyes in response to any stimulus
Motor Response:
Posturing status of patient:
Obeys commands (6)
Localizes pain (5) =
Normal flexion (4) = withdrawal from painful stimulus
Abnormal flexion (3) = decorticate posturing; abnormal flexion of arms/wrists in response to stimuli.
Extension (2) = decerebrate posturing; abnormal arm extension in response to stimuli.
No response (1) = no movement in response to painful stimulus.
Quality of verbalization
Oriented (5) = oriented to time, person, place
Confused conversation (4) = is confused regarding time, person, and/or place
Inappropriate words (3) = using words which make no sense in the context of the conversation.
Incomprehensible sounds (2) = No words or conversation, just sounds such as groaning.
None (1) = no words or sounds, even in response to stimuli.
• Invasive procedure that allows for detection of cerebral edema (↑ ICP) which could lead to compromised cerebral perfusion/injury.
ICP
When is an ICP indicated?
• Indicated for unconscious pts w/ GCS rating of <9
Pt presents a value of 20-25 on ICP
requires treatment
Primary complication of ICP
Infection
• Types (location) of ICP monitoring
1, intraventricular
- subarachnoid
- epidural
- subdural
- intraparenchymal
• ICP reduced via:
a) Osmotic diuresis (Mannitol)
b) Upright positioning (elevate HOB @ least 30 degrees)
c) CSF drainage
d) Proper head/neck alignment in neutral position.
e) Hyperventilation (↓ CO2)
f) IV sedation (↓ metabolic demand)
Calculated CPP
MAP - ICP
indicator of perfusion to the brain
CPP
Normal CPP; Critical level CPP
• N = 70-80 mmHg; critical level = < 60 mmHg (inadequate blood supply)
test for unconscious pts; pts head moved quickly side to side from the midline position.
doll’s eyes reflex
eyes deviate in opposite direction from side to which head is turned.
Intact doll’s eyes pupil assessment
eyes move in the direction that the head is turned, remain midline, or move in the opposite direction from one another.
Not intact doll’s eyes
brain tissue compression, atropine effect, eye injury.
dilated pupil
lower brain injury or narcotic use/overdose
pinpoint pupil
late sign of nerve (oculomotor) compression due to edema or mass.
change in pupil size (esp.unilateral change
non-reactive pupil - or brain ischemia if bilateral
• A sluggish response to light
cerebral edema
postural; best chance reversible, hands turn towards core
decoriticate
postural; hands/feet flip away from body
Decerebrate
Normal ICP
0-15 (7)
how to calculate MAP
((diastolic x2) + systolic) /3
Medications which are primarily administered to reduce anxiety
benzo
medications which are primarily administered to reduce pain
opiates
medications which are primarily administered as a sedative
versed (midazdam), diprivan (profolol)
