Neuro

Question 1

RASS

Answer 1

Richmond agitation-sedation scale
+4 combative=violent, immediate danger
+3 very agitated= pulls on lines or aggressive
+2 agitated= freq. non-purposeful movement, dyssynchrony with vent
+1 restless= anxious, apprehensive
0 alert and calm
-1 drowsy= not fully alert but >10secs awake with eye contact to voice
-2 light sedation= <10sec awake with eye contact to voice
-3 moderate sedation= any movement (not eye contact) to voice
-4 deep sedation= no response to voice, but yes to physical stimulation
-5 unarousable

Question 2

Muscle strength

Answer 2

Grade
0/5 no movement
1/5 movement without joint motion
2/5 movement with gravity eliminated
3/5 movement against gravity but not resistance
4/5 movement against gravity and light resistance
5/5 full

Question 3

Hunt and Hess

Answer 3

Grading system to classify severity of SAH and predict mortality (%)
0 unruptured aneurysm, no symptoms (0%)

1 asymptomatic or minimal HA, slight nuchal rigidity

2 severe HA, stiff neck, no neuro deficits except CN palsy

3 drowsy, confused, mild focal deficits

4 stuporous, mod-severe hemiparesis

5 coma, decerebrate (70-77%)

Question 4

Modified fisher/ Claassen

Answer 4

Severity of SAH based on amount and type of blood on CT with associated vasospasm risk

Grade
0 no SAH or IVH
1 minimal SAH, no IVH
2 minimal SAH, bilateral IVH
3 thick SAH (completely filling 1 or more cistern or fissure) without bilateral IVH
4 thick SAH and bilateral IVH

Question 5

Confusion assessment method (CAM)

Answer 5

Diagnosis of delirium, requires presence of 1 and 2 and (3 or 4)

1 acute onset, fluctuating course

2 in attention

3 disorganized thinking

4 ALOC

Question 6

ASIA

Answer 6

American spinal injury association (ASIA) impairment scale

A complete= no motor, no sensory, no sacral sparing

B incomplete= no motor, only sensory

C incomplete= 50% muscle less than grade 3 (best= move against gravity)

D incomplete= 50% muscle more than grade 3 (>/= move against light resistance)

E normal