Neuro

Question 1

GCS

Answer 1

Scoring system with strong correlation to severity of head injury. (Severe <8, Moderate 9-12, Mild 13-15)

E - 4
V - 5
M - 6

Question 2

Elevated ICP and Ketamine

Answer 2

Maintain spontaneous respirations

Undesirable increase SNS tone, cerebral blood flow, & regional CMRO2

However, small in comparison to hypoxia, hypercarbia, loss of airway

Question 3

C-Spine Clearance

Answer 3

1. Absence cervical pain or tenderness
2. Absence paresthesias or neuro deficits
3. Normal mental status
4. No distracting pain
5. Age >4 yrs

Note: 7% of fractures missed with radiographic exams (x-ray or CT) and ligamentous injury is not ruled out

Question 4

Head Injury and Hypertension/Tachycardia

Answer 4

DDx: pain, hypoxia, hypercarbia, hypovolemia, anemia, hyperdynamic response to head injury

Lower? If level could lead to MI or cerebral infarction with short acting agent (esmolol vs cleviprex)
However, difficult to know cause (increase ICP vs above)
Therefore; reduce ICP, neurosurgeon for ICP monitoring, adequate analgesia/volume replacement/ventilation

Would not attempt to normalize to ensure adequate cerebral perfusion pressure

Question 5

TBI and Ideal CPP

Answer 5

60-70 mm Hg

Above = ARDS
Below = Cerebral ischemia

(Cerebral autoregulation maintains CBF at constant rate with MAP 60-150 mm Hg)

Question 6

Lower ICP

Answer 6

Brain - 
     Crani
Blood - 
     Venous drainage (r/o obstruction, head 15-30)
     Barb
     Hypervent
CSF
     Mannitol +/- Lasix
     EVD

Question 7

Hyponatremia

Answer 7

DDx: CSWS vs SIADH

CSWS: hypovolemia, nml ADH, urine Na >100
Treatment -
SIADH: normovolemia, ADH high, urine Na <100
Treatment - H2O restrict, diuresis, demeclocycline, Na replacement

Question 8

Cushing Response

Answer 8

1. Increase BP
2. Reflex bradycardia
3. Irregular respirations or widened pulse pressure

Dilated and nonreactive pupil = CN3 (oculomotor) compression from uncal herniation

Question 9

Mannitol

Answer 9

Osmotic diuresis, decreases CSF production, reflex vasoconstriction

Complications:
Worsening cerebral edema - BBB not intact
Expansion of hematoma - intracranial bleed