Neuro Flashcards
5 major components
level of consiouness
motor function
eye signs
respirator
vital signs
what is the earliest and most reliable indicator of increased ICP
level of consiousness
GCS
normal ICP
0-15
what is bad ICP
sustained above 20
what is the way to assess for motor to pain
trapezius squeeze
GCS
motor
eyes
verbal
decorticate
into the core
flexion
decerebrate
externsion
down
dermatomes is best for
spinal injury
who might have decreased smell
elderly
why is pupils PERRL and not PERRLA
A is accommodation and we normally do not turn lights off
anisocoria
unequal pupils
diplopia
double vision
corneal reflex
touch eye and see if reflex
oculocephalic reflex is also called
dolls eyes
what is normal for dolls eyes
turn eyes to the side (follow)
occulovestibular
cold caloric test
cold caloric test normal
syrginge of cold water into ear and eyes should go to that sidel
lid lag
eye does not close all the way
central neurogenic hyperventilation
increase RR
cushings triad tells us what
INCREASE ICP
what is cushings triad
widened pulse pressure (increase sbp)
decrease pulse
decrease respiration
what is herniated
push brain tissue else where
s/s of basilar fracture
raccoons eyes
halo sign
battle sign
ptosis
eye drooping
homonymous hemianopsia
lose vision on one side
- the side of the name is the side of lacking of vision
vision changes mean it is worse or better
worse
tardive dysnekeisa is caused by
psych meds
- newer ones not so much
what is a seizure
increase brain activity
usually underlying cause
what are some causes of seizure
alcohol
withdrawl
electrolyte
tumor
trauma
flashing lights
aura
subjective
what meds to stop the seizure
valium or ativanIV
what to do if having a seizure
put on side
clear the area around
nothing in mouth
what is lacking in coma
arousal and awareness
are comas always caused by one cause
no can be multiple
what are the 2 main categories of coma
structural
metabolic
what do we need to do with our assessment for coma
REPEAT
persistent vegetive state
either full coma or wake up a little but still no awareness
what is known as mini stroke
TIA
know modifiable vs nonmodifable
hemorrhaging vs ischemic
hemorrhaging is bleeding
ischemic is occulsion
what is the majority of strokes
ischemic
TIA
transit ischemic attack is a temporary neulogoci defect caused by cerebrovascular disease that leaves no imaging or clinical trace
can ishemic turn into hemorrhagic
yes
greatest risk factor for ischemic stroke
hypertension
* also dyslipidemia, diabetes, smoking, carotid atherosclerosis, a fib
treatment for ischemic stroke
fibrinolytic therapy
AKA TPA
time for TPA
3-4 hours
brain stem
N/V
hemorrhage
decrease LOC
carotid
numbness
language
veretebrobasilar
visual
paralysis
vertigo
door to CT
25 min
Door to ct READ
45 min
door to thrombolytic therapy
60 min
NIHHS range
0-42
why might want to keep BP generally high in ischemic
ensure blood flow
when do we treat for ischemic
- when is BP too high
SBP 220
DBP 120
MAP 130
what do we want to do before TPA adminstration
IV, foley, end
cause HIGH BLEEDING RISK
indicator to brain bleed
ICP
BE FAST
balance
eyes
facial droop
arm
speach
time
causes of a subarachnoid hemorrhage `
cerebral anerysm or AVM bleed
S/s of subarachnoid hemorrhage
WORST HEADACHE EVER
best way to find cerebral aneurysm
CT scanh
how to fix cerebral ansrsum
clip= rupture
coil= no rupture
subarchanonoid hemorrhage triple H therapy
hypertensive
hypervolemic
hemodilutuon
epidural hematoma S/s
lose consciousness
lucid
rapid deterioration
normally feel better after consciousness regained but then could die
acute subdural
deteriorate in first 24 hours
subacute subdural
4-21 days
chronic subdural
after 21
* might not even remember hitting head
intracerebral is associated with
trauma and answesym
diffuse axonal injury
shearing of neurons
SPINING/TURNING
how will CT look in diffuse axonal injury
normal
- multiple little spots of bleeding
secondary injurt
anything that results from that primary injurt
more seconday
more risk of death
normal ICP
0-15
cerebral perfusion pressure
how much blood pressure flow to brain
normal CPP
70-100
how to calculate CPP
MAP-ICP
Uncial herniation
pushing of Brain tissue else where
- cells, CSF, blood
what can cause herniation
increase ICP=sodium, straining, exercise, stress, suctioning, coughing
do not want ICP sustained over20
how to calculate MAP
(2x DBP) + SBP
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