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Neuro Flashcards

1
Q

head injuries range from

A

mild concussion-coma-death

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2
Q

what are the most serious head injuries

A

traumatic brain injuries (TBI)

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3
Q

tbi’s result from

A

falls, mva’s, blunt trauma’s/assaults

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4
Q

what is a primary injury

A

the inital damage to the brain

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5
Q

why is knowing the primary injury important

A

we need to know what happened and how his person got the injury

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6
Q

name some primary injuries

A 
contusions
lacerations
ruptured bv's
penetration
acceleration/decelaration of injury
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7
Q

what is a secondary injury

A

an injury that results from the primary but occurs hours to days after the initial injury

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8
Q

how do secondary injuries occur

A

inadequate o2 delivery to the cells

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9
Q

name the different types of head injuries

A 
epidural hematoma
subdural hematoma
subarachnoid hemmorhage
intracerebral space occupying lesion
cerebral aneurysm
intracranial pressure
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10
Q

what happens if the brain enters the foramen magnus

A

herniation
cannot maintain bp
cannot maintain blood circulation to the brain

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11
Q

what is imminent if herniation occurs

A

PT WILL DIE

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12
Q

normal icp range

A

0-10/15

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13
Q

what icp is cocerning

A

above 20

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14
Q

def the monroe kelly hyppothesis

A

an increase in any one of the components(brain, blood, csf) causes a change in the volume of others

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15
Q

how do we assess icp

A

=ICP with a mental status change/s

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16
Q

what medication is given for cerebral edema

A

mannitol

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17
Q

name the different kinds of hematomas

A

epidural
subdural
subarachnoid
intracerebral

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18
Q

epidural means

A

above the dura

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19
Q

subdural means

A

below the dura

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20
Q

cerebral ischemia results from

A

compression by a hematoma

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21
Q

epidural hematoma occurs in what location

A

btw the skull and the dura mater

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22
Q

what injury is at highest risk for epidural hematoma?

A

skull fracture

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23
Q

skull fractures cause what kind of injury

A

rupture to middle meningeal artery

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24
Q

what occurs as a result of middle meningeal artery rupture

A

decreased delivery of 02
high pressure causes bleeding and swelling
fast bleed
quick neuro status change

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25
Q

clinical manifestations of epidural hematoma

A

marked neuro deficit
brief loss of consciousness
icp maintenance

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26
Q

what are the compensatory mechs of epidural hematoma

A

pressure on the brain
maintenance of ICP
brief loss of consciousness

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27
Q

explain how maintenance of icp compensates during an epidural hematoma

A

rapidly absorbs csf

decreases intravascular volume

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28
Q

what else occurs during the compensatory mechs during an epidural hematoma

A

angiotensin fires

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29
Q

what intervention is done for epidural hematoma

A

craniotomy

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30
Q

benefits of a craniotomy

A

relieves pressure
remove clot or control bleeding
drain excess blood/fluids

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31
Q

the subdural hematoma occurs at which location

A

btw the dura and the brain

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32
Q

what causes subdural hematomas

A

trauma
coagulopathies
aneurysms

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33
Q

what occurs as a result of subdural hematoma

A

venous bleed- rupture of small bv’s that bridge the subdural space

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34
Q

what will you see from a pt with a venous bleed

A

small/no decline in neuro status

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35
Q

is a venous bleed normally slow or fast?

A

slower- smaller vessels and little pressure

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36
Q

how often do we check our pt with a venous bleed

A

at least q 1 hr neuro checks

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37
Q

subdural hematomas can be …

A

acute
subacute
chronic

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38
Q

acute subdural hematomas usually occur following…

A

a fall

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39
Q

a subacute subdural hematoma usually occur when?

A

post- trauma

a day -a few days after the initial injury

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40
Q

how do chronic subdural hematomas occur

A

coagulation problems

chronic high bp

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41
Q

name the causes of subarachnoid hematoma

A 
AVM
intracranial aneurysm (circle of willis)
trauma
HTN
hemorrhagic stroke (bleeding in one of your cerebral arteries)
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42
Q

what is an AVM

A

vessel netwrok in brain knots up

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43
Q

what is reported from patients with AVM’s

A

constant headaches

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44
Q

t/f - avm’s can be resected

A

true

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45
Q

a chiari is a type of

A

avm

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46
Q

what is the circle of willis

A

bv’s that supply blood to the brain at the base

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47
Q

why do many aneurysms occur at the circle of willis

A

there are many weaknesses here at the bifurcations in the bv walls

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48
Q

intracerebral hemorrhages occur

A

directly inside the brain

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49
Q

what are intracerebral hemorrhages caused by

A

head injuries- force exterted over a small area

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50
Q

patients will complain of what during an intracerebral hemorrhage

A

headache

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51
Q

def intracranial aneurysm

A

dilation of the walls of a cerebral artery that develops asa result of weakness in the arterial wall

52
Q

where do intracranial aneurysms occur?

A

bifurcations of the large arteries

53
Q

intracranial aneurysms are caused by

A 
atherosclerosis
congenital defect
hypertensive vascular disease
head trauma
increased age
54
Q

a neuro assessment includes

A

increased icp
pathological reflexes
brain death criteria
end of life criteria- organ donation, advance directives

55
Q

as icp increases, perfusion _______

and causes

A

decreases;
ischemic events
strokes
resp and cardiac changes

56
Q

increased ICP criteria

A

15-40

57
Q

when do we start to intervene for increased icp

A

20

58
Q

what will you see in a pt with increased icp

A

slow bounding pulse

RR irregularities

59
Q

increased icp results in

A

decreased cerebral perfusion
ischemia
further edema
shifts brain tissue (herniation)

60
Q

what causes increased icp

A

head injury
hemorrhage
tumors
encephalopathy

61
Q

t/f- the more acidotic you are, the harder it is to perfuse the brain (constricted)

A

true

62
Q

if you decrease CO2, you are treating

A

vasoconstriction

63
Q

if you increase CO2, you are treating

A

vasodilation

64
Q

how do we monitor icp

A

ventriculostomy

65
Q

how does a ventriculostomy work

A

cath measures icp, drains blood/fluid to allow more space in the vault

66
Q

how do we reduce cerebral edema

A

mannitol (osmotic diuretic), dehydrate the brain
fluid restriction
induced hypothermia
maintain bp- MAP approx 100, systolic 160-180
control fever
oxygenation
ABG’s

67
Q

what is a normal CPP range

A

70-100 mm HG

68
Q

formula for CPP

A

MAP- ICP= CPP

69
Q

cpp should be maintained bx…. for adequate blood flow to the brain

A

70-80

70
Q

if ICP= MAP…. what will occur

A

cerebral blood flow will cease

71
Q

what is cushing’s reflex

A

when the blood flow to the brain (cerebral) decreases singificantly

72
Q

name the criteria for cushing’s triad

A

hypertensive
bradycardic
widening pulse pressure

73
Q

what is decorticate posturing

A

limbs move inward towards the cord

74
Q

what will you see with decorticate posturing

A

limbs move inward toward cord
shoulders shrug slightly
toes turn inward

75
Q

what is decerebrate posturing

A

limbs move away from the cord

76
Q

both decorticate and decerebrate posturing mean what

A

death/end neuro status

77
Q

decort/decere posturing is a turning point with what 2 end results

A

responsiveness

herniation

78
Q

brain death

A

severe head injury
incompatible with life
irreversible loss of all brain fx
beyond the help of tx

79
Q

do we assess for brain death

A

no- neurologist or ICU attending, but we do aid and we do our neuro checks

80
Q

what must occur for someone to be declared brain dead?

A

must be officially assessed

must be officially declared

81
Q

what else is looked at/looked for at the declaration of brain death

A

potential organ donation

advance directives

82
Q

what are the 3 cardinal signs of brain death

A

coma
absence of brain stem reflexes
apnea

83
Q

how is apnea defined in terms of neuro/brain impairment

A

not taking additional breaths above the machine setting

84
Q

how is apnea assessed

A

machine is shut off for a period of time
increase in co2 should illicit a resp reflex to take a breath
in brain death, no sucj reflex occurs

85
Q

how is coma status declared

A

no response to noxious stimuli (non-painful and painful)

86
Q

name the brain stem reflexes that are tested to declare brain death

A

pupillary
eye mvmt
gag/cough

87
Q

how will the pupils look if brain death is declared

A

fixed, no rxn

88
Q

name the 3 criteria for having no eye mvmts

A

dolls eyes
cold caloric
corneal reflex

89
Q

dolls eyes

A

tests the ocular CN
move head from midline to side
assess if eyes move or stay fixed
if eyes stay forward- bad response= brain death

90
Q

cold caloric reflex

A

place ice cold water in the ear
eyes should move to that side
if not= brain death

91
Q

corneal reflex

A

touch sclera with q tip

look for blink reflex

92
Q

how else is the corneal reflex illicited

A

clap near ur face

blow air into the eye

93
Q

how is SCI disability defined

A

complete or incomplete plegia

94
Q

def paraplegia

A

paralysis of the lower body

95
Q

def tetraplegia

A

paralysis of all 4 extremities

96
Q

why is transection injury significant

A

no neuro status or reflexes below the transection/point of injury

97
Q

where is the most common injuries

A

c5-c7 (cervical vertebrae)

98
Q

where are the other more common injuries

A 
t12 (thoracic)
L 1 (lumbar)
99
Q

how do we prevent secondary injuries

A

use of boards

c collar

100
Q

SCI manifestations depend on what?

A

type and level of injury

101
Q

incomplete SC lesion

A

sensory and/or motor fibers (or both) are preserved below the lesion

102
Q

spinal cord lesions are classified according to

A

area of SC damage

103
Q

name the areas of spinal cord damage

A

central
lateral
anterior
peripheral

104
Q

def complete spinal cord lesion

A

total loss of sensation and voluntary muscle control below the lesion (tetraplegia)

105
Q

SCI manifestations

A

pain- acute, neck, back

resp dysfx

106
Q

diaphragm involvement/impairment at which level

A

c4 or above

107
Q

impairment of IC muscles and abdominal muscles at which level

A

T1-T11

108
Q

SCI emergency mgmt

A 
rapid assessment
immobilization
extrication
stabilization
control life threatening injuries
should be taken to level 1 trauma center
109
Q

def extrication

A

getting someone out of a tight spot while stabilizing their SC

110
Q

SCI mgmt (regular)

A 
prevent secondary injury
monitor for progressive neurological deficits
prevent complications- resp, VTE, infecs
IV corticosteroids
oxygenation
fracture stabilization
traction
surgery
111
Q

how should a SCI patient be turned

A

4-5 ppl

log roll

112
Q

list SC precautions

A

head of bed flat or in reverse trendelenberg
q 1 hr checks
sensory and motor checks

113
Q

what is a halo device

A

a long term cervical collar to maintain SC stabilization

114
Q

what specialty bed is needed for SCI pt

A

a bed locked in flat or reverse trendelenberg position

115
Q

what surgeries may be done for SCI pt

A 
fusions
rods
screws
plates
align
remove disks
116
Q

why are IV corticosteroids used for SCI patients

A

to reduce the swelling at the injury site

117
Q

SCI assessment

A

level of injury

impact on ADL’s

118
Q

why is level of injury important?

A

to understand what the neurological injury means and what it effects

119
Q

the higher the injury, the more _______ the patient will be

A

dependant

120
Q

if a patient has a C1-4 injury, describe the ADL’s

A

dependant for dressing, eating, elimination, and mobility

121
Q

if a patient has a C4- below injury, describe the ADl’s

A

assistance- maximal to dependant

122
Q

name the SCI complications

A 
spinal shock
resp failure
DVT
autonomic dysrefexia
pressure ulcers
infections
123
Q

what is spinal shock

A

sudden depression of reflex activity in the SC (areflexia) below the level of injury

124
Q

how does resp failure occur as a result of SCI

A

innervation of the major resp muscles is lost

125
Q

def autonomic dysrefexia

A

a systemic response that happens after the SCI and is related to their injury

126
Q

autonomic dysreflexia clinical manifestations

A 
pounding headache
profuse sweating
nasal congestion
goose bumps
bradycardia
hypertension
127
Q

t/f- autonomic dysreflexia is very common

A

false- rare

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