Neuro Flashcards
1
Q
head injuries range from
A
mild concussion-coma-death
2
Q
what are the most serious head injuries
A
traumatic brain injuries (TBI)
3
Q
tbi’s result from
A
falls, mva’s, blunt trauma’s/assaults
4
Q
what is a primary injury
A
the inital damage to the brain
5
Q
why is knowing the primary injury important
A
we need to know what happened and how his person got the injury
6
Q
name some primary injuries
A
contusions lacerations ruptured bv's penetration acceleration/decelaration of injury
7
Q
what is a secondary injury
A
an injury that results from the primary but occurs hours to days after the initial injury
8
Q
how do secondary injuries occur
A
inadequate o2 delivery to the cells
9
Q
name the different types of head injuries
A
epidural hematoma subdural hematoma subarachnoid hemmorhage intracerebral space occupying lesion cerebral aneurysm intracranial pressure
10
Q
what happens if the brain enters the foramen magnus
A
herniation
cannot maintain bp
cannot maintain blood circulation to the brain
11
Q
what is imminent if herniation occurs
A
PT WILL DIE
12
Q
normal icp range
A
0-10/15
13
Q
what icp is cocerning
A
above 20
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
15
Q
how do we assess icp
A
=ICP with a mental status change/s
16
Q
what medication is given for cerebral edema
A
mannitol
17
Q
name the different kinds of hematomas
A
epidural
subdural
subarachnoid
intracerebral
18
Q
epidural means
A
above the dura
19
Q
subdural means
A
below the dura
20
Q
cerebral ischemia results from
A
compression by a hematoma
21
Q
epidural hematoma occurs in what location
A
btw the skull and the dura mater
22
Q
what injury is at highest risk for epidural hematoma?
A
skull fracture
23
Q
skull fractures cause what kind of injury
A
rupture to middle meningeal artery
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
25
clinical manifestations of epidural hematoma
marked neuro deficit
brief loss of consciousness
icp maintenance
26
what are the compensatory mechs of epidural hematoma
pressure on the brain
maintenance of ICP
brief loss of consciousness
27
explain how maintenance of icp compensates during an epidural hematoma
rapidly absorbs csf
| decreases intravascular volume
28
what else occurs during the compensatory mechs during an epidural hematoma
angiotensin fires
29
what intervention is done for epidural hematoma
craniotomy
30
benefits of a craniotomy
relieves pressure
remove clot or control bleeding
drain excess blood/fluids
31
the subdural hematoma occurs at which location
btw the dura and the brain
32
what causes subdural hematomas
trauma
coagulopathies
aneurysms
33
what occurs as a result of subdural hematoma
venous bleed- rupture of small bv's that bridge the subdural space
34
what will you see from a pt with a venous bleed
small/no decline in neuro status
35
is a venous bleed normally slow or fast?
slower- smaller vessels and little pressure
36
how often do we check our pt with a venous bleed
at least q 1 hr neuro checks
37
subdural hematomas can be ...
acute
subacute
chronic
38
acute subdural hematomas usually occur following...
a fall
39
a subacute subdural hematoma usually occur when?
post- trauma
| a day -a few days after the initial injury
40
how do chronic subdural hematomas occur
coagulation problems
| chronic high bp
41
name the causes of subarachnoid hematoma
```
AVM
intracranial aneurysm (circle of willis)
trauma
HTN
hemorrhagic stroke (bleeding in one of your cerebral arteries)
```
42
what is an AVM
vessel netwrok in brain knots up
43
what is reported from patients with AVM's
constant headaches
44
t/f - avm's can be resected
true
45
a chiari is a type of
avm
46
what is the circle of willis
bv's that supply blood to the brain at the base
47
why do many aneurysms occur at the circle of willis
there are many weaknesses here at the bifurcations in the bv walls
48
intracerebral hemorrhages occur
directly inside the brain
49
what are intracerebral hemorrhages caused by
head injuries- force exterted over a small area
50
patients will complain of what during an intracerebral hemorrhage
headache
51
def intracranial aneurysm
dilation of the walls of a cerebral artery that develops asa result of weakness in the arterial wall
52
where do intracranial aneurysms occur?
bifurcations of the large arteries
53
intracranial aneurysms are caused by
```
atherosclerosis
congenital defect
hypertensive vascular disease
head trauma
increased age
```
54
a neuro assessment includes
increased icp
pathological reflexes
brain death criteria
end of life criteria- organ donation, advance directives
55
as icp increases, perfusion _______
| and causes
decreases;
ischemic events
strokes
resp and cardiac changes
56
increased ICP criteria
15-40
57
when do we start to intervene for increased icp
20
58
what will you see in a pt with increased icp
slow bounding pulse
| RR irregularities
59
increased icp results in
decreased cerebral perfusion
ischemia
further edema
shifts brain tissue (herniation)
60
what causes increased icp
head injury
hemorrhage
tumors
encephalopathy
61
t/f- the more acidotic you are, the harder it is to perfuse the brain (constricted)
true
62
if you decrease CO2, you are treating
vasoconstriction
63
if you increase CO2, you are treating
vasodilation
64
how do we monitor icp
ventriculostomy
65
how does a ventriculostomy work
cath measures icp, drains blood/fluid to allow more space in the vault
66
how do we reduce cerebral edema
mannitol (osmotic diuretic), dehydrate the brain
fluid restriction
induced hypothermia
maintain bp- MAP approx 100, systolic 160-180
control fever
oxygenation
ABG's
67
what is a normal CPP range
70-100 mm HG
68
formula for CPP
MAP- ICP= CPP
69
cpp should be maintained bx.... for adequate blood flow to the brain
70-80
70
if ICP= MAP.... what will occur
cerebral blood flow will cease
71
what is cushing's reflex
when the blood flow to the brain (cerebral) decreases singificantly
72
name the criteria for cushing's triad
hypertensive
bradycardic
widening pulse pressure
73
what is decorticate posturing
limbs move inward towards the cord
74
what will you see with decorticate posturing
limbs move inward toward cord
shoulders shrug slightly
toes turn inward
75
what is decerebrate posturing
limbs move away from the cord
76
both decorticate and decerebrate posturing mean what
death/end neuro status
77
decort/decere posturing is a turning point with what 2 end results
responsiveness
| herniation
78
brain death
severe head injury
incompatible with life
irreversible loss of all brain fx
beyond the help of tx
79
do we assess for brain death
no- neurologist or ICU attending, but we do aid and we do our neuro checks
80
what must occur for someone to be declared brain dead?
must be officially assessed
| must be officially declared
81
what else is looked at/looked for at the declaration of brain death
potential organ donation
| advance directives
82
what are the 3 cardinal signs of brain death
coma
absence of brain stem reflexes
apnea
83
how is apnea defined in terms of neuro/brain impairment
not taking additional breaths above the machine setting
84
how is apnea assessed
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
how is coma status declared
no response to noxious stimuli (non-painful and painful)
86
name the brain stem reflexes that are tested to declare brain death
pupillary
eye mvmt
gag/cough
87
how will the pupils look if brain death is declared
fixed, no rxn
88
name the 3 criteria for having no eye mvmts
dolls eyes
cold caloric
corneal reflex
89
dolls eyes
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
cold caloric reflex
place ice cold water in the ear
eyes should move to that side
if not= brain death
91
corneal reflex
touch sclera with q tip
| look for blink reflex
92
how else is the corneal reflex illicited
clap near ur face
| blow air into the eye
93
how is SCI disability defined
complete or incomplete plegia
94
def paraplegia
paralysis of the lower body
95
def tetraplegia
paralysis of all 4 extremities
96
why is transection injury significant
no neuro status or reflexes below the transection/point of injury
97
where is the most common injuries
c5-c7 (cervical vertebrae)
98
where are the other more common injuries
```
t12 (thoracic)
L 1 (lumbar)
```
99
how do we prevent secondary injuries
use of boards
| c collar
100
SCI manifestations depend on what?
type and level of injury
101
incomplete SC lesion
sensory and/or motor fibers (or both) are preserved below the lesion
102
spinal cord lesions are classified according to
area of SC damage
103
name the areas of spinal cord damage
central
lateral
anterior
peripheral
104
def complete spinal cord lesion
total loss of sensation and voluntary muscle control below the lesion (tetraplegia)
105
SCI manifestations
pain- acute, neck, back
| resp dysfx
106
diaphragm involvement/impairment at which level
c4 or above
107
impairment of IC muscles and abdominal muscles at which level
T1-T11
108
SCI emergency mgmt
```
rapid assessment
immobilization
extrication
stabilization
control life threatening injuries
should be taken to level 1 trauma center
```
109
def extrication
getting someone out of a tight spot while stabilizing their SC
110
SCI mgmt (regular)
```
prevent secondary injury
monitor for progressive neurological deficits
prevent complications- resp, VTE, infecs
IV corticosteroids
oxygenation
fracture stabilization
traction
surgery
```
111
how should a SCI patient be turned
4-5 ppl
| log roll
112
list SC precautions
head of bed flat or in reverse trendelenberg
q 1 hr checks
sensory and motor checks
113
what is a halo device
a long term cervical collar to maintain SC stabilization
114
what specialty bed is needed for SCI pt
a bed locked in flat or reverse trendelenberg position
115
what surgeries may be done for SCI pt
```
fusions
rods
screws
plates
align
remove disks
```
116
why are IV corticosteroids used for SCI patients
to reduce the swelling at the injury site
117
SCI assessment
level of injury
| impact on ADL's
118
why is level of injury important?
to understand what the neurological injury means and what it effects
119
the higher the injury, the more _______ the patient will be
dependant
120
if a patient has a C1-4 injury, describe the ADL's
dependant for dressing, eating, elimination, and mobility
121
if a patient has a C4- below injury, describe the ADl's
assistance- maximal to dependant
122
name the SCI complications
```
spinal shock
resp failure
DVT
autonomic dysrefexia
pressure ulcers
infections
```
123
what is spinal shock
sudden depression of reflex activity in the SC (areflexia) below the level of injury
124
how does resp failure occur as a result of SCI
innervation of the major resp muscles is lost
125
def autonomic dysrefexia
a systemic response that happens after the SCI and is related to their injury
126
autonomic dysreflexia clinical manifestations
```
pounding headache
profuse sweating
nasal congestion
goose bumps
bradycardia
hypertension
```
127
t/f- autonomic dysreflexia is very common
false- rare
