Neuro 4 Flashcards
Using PEEP or PAP decreases
MAP and CPP
A rise in mean airway pressure can increase
ICP
Induced hypernatremia
increases CPP and decreases intracerebral pressure
where is hypertonic saline given
2% saline can be given peripheral, 3% or higher is given central
hyperventilation or any lowering/drop of CO2 less than 25 mmHg will cause…
vasoconstriction to the cerebral arteries.
what is limited in neuro pts as it increases ICP
Suctioning is limited to 5-10 seconds and no coughing
describe Permissive hypercapnia
Allow CO2 to go a little higher, allows them to have a better depth of respiration
if GCS less than 8 goals are…
Reduce agitation, discomfort and pain
Use mechanical ventilation to decrease coughing
Limit suctioning
if sedating neuro pt what is important to remember
must be able to wake them up! (need to know if sedated d/t increased ICP or just meds)
what can paralyzation cause
may decrease brain activity
what meds are used most often for ICP
Ativan/Lorazepam and Fentanyl drips used most often
what is a Barbiturate coma
- to put into sedated coma to reduce brain metabolism
- used for less than 72 hours
- Used GCS less than 7, ICP greater than 25
other than coma, what is used to slow brain metabolism
hypothermia
what drug reverses a paralyzing agent
romazicon
what type of additional management when dealing with increased ICP
Blood Pressure management to keep normotensive, avoid MAP greater than 110
Induces muscle paralysis
Used to decrease brain activity
Neuromuscular Blockade
induced hypothermia
to slow brain metabolism
no longer than 72 hours, medicate for shivering
some management of increased ICP
- Decompressive Craniectomy
- Positioning- neutral position
- Environmental Stimuli- decrease noxious stimuli, bright lights, smells, anxiety
how do you prevent poor blood flow to the brain
Maintain head in alignment
what do you use when neuro pt has fever
cooling blankets
fever increases metabolism, want to decrease this
most common sedation drugs
versed, fentanyl, propofol
what must be performed to determine brain death
- Coma
- Normal or near normal body temperature
- Normal systolic blood pressure
- At least one neurologic examination
- Tests: Cerebral angiogram, EEG, Cerebral CT
- GCS of 8 or less, contact organ procurement
how do you know they are brain dead?
- Two EEGs (brain wave activity??)
- can they breathe on their own?? (maintain basic involuntary function of breathing, shunt off vent and see if they can breathe off vent and maintain O2 sat)
what are reversible causes
must exclude these causes before determining brain death!
reversible causes examples
- check blood sugar
- intoxicated (alcohol?)
- depressant drugs (muscle relaxant OD?)
- hypothermia
- hypovolemic shock
what should you consider about a dead pt
NEVER cold and dead, must be WARM and dead (give you warm saline to determine death)
describe a Cerebrovascular Accident- Stroke
Sudden impairment in cerebral circulation, decreases oxygenation
goal of a stroke
is to restore oxygenation
causes of stroke
Thrombosis, Embolism or Hemorrhage
risk factors of stroke
HTN, TIA, Arrhythmias, DM, Smoking, Alcohol intake, Contraceptives
describe a thromboembolitic stroke
(came from the heart…) clot in the brain preceded by TIAs
a CVA image showing a brain without folds means…
it is swollen
a CVA image showing enlargement within meninges
means there is a lot of fluid in them
s/s of middle cerebral artery stroke
- Aphasia
- Dysphasia
- Dyslexia
- Dysgraphia
- Visual field cuts
- Hemiparesis on the affected side, more severe in the face and arm than in the leg
s/s of internal carotid artery stroke
Headache Weakness Paralysis Numbness Sensory Changes Visual changes Change in LOC Aphasia Ptosis Bruits over carotids
this is the most common stroke
middle cerebral artery
