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monster management > neuro > Flashcards

neuro Flashcards

1
Q

autoregulation fails when? x2

A

MAP
under 60
greater than 150

(cerebral flow depends on SBP)

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2
Q

cerebral perfusion pressure equation

A

CPP = MAP - ICP

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3
Q

circle of willis

A

compensates for decreased bloodflow in order to maintain perfusion

  • posterior cerebral arteries
  • posterior communicating arteries
  • internal carotid arteries
  • anterior cerebral arteries
  • anterior communicating artery
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4
Q

subarachnoid hemorrhage is

A

caused by bleeding in arachnoid space, between pia & arachnoid membrane
- blood mixes w CSF around brain/spinal cord
- results:
↑ ICP
↓CPP
meningeal irritation
↓ CSF reabs into venous sys

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5
Q

SAH causes

A

traumatic

non-traumatic: ruptured aneurysm (85%), ruptured AVM, tumor

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6
Q

“worst headache of my life”

A

think SAH!

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7
Q

SAH: s/s

A
  • “worst hHA of my life”
  • n/v/projectile
  • seizure/LOC
  • unilateral pupil dilation
  • photophobia, visual ∆s
  • nuchal rigidity (4-6 hrs later)
  • CN III, IV, VI deficits (eyes do tricks)
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8
Q

Hunt Hess Score for?

A

SAH mortality

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9
Q

SAH imaging

A

non-con head CT + head CTA /OR/ LP

- usually CTA esp if higher susp SAH vs meningitis

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10
Q

blood in LP classic for

A

SAH

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11
Q

SAH tx: SBP goal, htn, hypotn (rx x4)

A

SBP goal 120 - 130

htn: IV labetalol, nicardipine
hypo: levophed (↑MAP), dopamine works too

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12
Q

SAH tx traumatic vs aneurysmal tx

A

traumatic: neurosurg intervention
aneurysmal: coiling, clipping

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13
Q

why are vasospasms + SAH bad?

A

decreases perfusion

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14
Q

SAH tx total

A
  • SBP 120 - 130 (maintain perfusion)
  • intervention: neurosurg, coil, clip
  • avoid hyperthermia (38+C) & hypoglycemia (BG 60+)
  • monitor
    • rebleed (ICU 2-3 wk for monitor)
    • aseptic fever r/t central reg of hypothalamus
    • SIADH r/t pituitary malfxn
    • vasospasm, ↑ ICP, cerebral ischemia
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15
Q

aseptic fever + SAH

A

r/t central regulation of hypothalamus

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16
Q

SIADH + SAH

A

r/t pituitary malfxn

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17
Q

cushing reflex

A

aka vasopressor response aka cushing effect aka phenomenon etc

physiological nervous system response to increased ICP that results in cushing’s triad

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18
Q

cushing’s triad

A

indicative of increased ICP - late stages, brain herniation imminent

  • ↑ BP
  • cheyne stokes breathing
  • ↓ HR
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19
Q

CTA vs head CT with contrast

A

angiogram: specific type of CT w contrast - timed so it will highlight arteries or veins of interest

CT will be timed to show capillary beds of soft tissues

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20
Q

arteriovenous malformation

A

congenital defect of circulatory system, tangled arteries & veins bypass capillary beds

21
Q

AVM s/s

A

progressive neuro sx: seizure, vertigo, HA, dysarthria, memory deficits, risk for rupture

22
Q

AVM tx

A

endovascular embolization, surgical resection, radiosurgery, combo

23
Q

linear skull fracture

A

no bone depression

24
Q

depressed skull fracture

A

outer table of skull depressed below inner table

25
Q

basilar skull fracture types x3 + 1 associated

A

anterior fossa: raccoon eyes + rhinorhea

middle fossa: battle sign + CSF (tympanic membrane)

posterior fossa

associated dural tear results in rhinorrhea, otorrhea, increased risk infection1

26
Q

raccoon eyes sign of

A

anterior fossa basilar skull fracture

27
Q

battle sign indicative of

A

middle fossa basilar skull fracture

28
Q

supratentorial (uncal) herniation

A

Shifting of lateral temporal lobe (uncas) → tentorial notch = compression of lateral midbrain, third cranial nerve, & posterior cerebral artery

29
Q

supratentorial (uncal) herniation: s/s

A

Sluggish to dilated pupils
Contralateral hemiparesis/hemiplegia
Restlessness deteriorating to loss of consciousness
Respiratory changes: Cheyne-stokes, ataxic pressure
Decorticate & decerebrate posturing
Dilated fixed pupils, flaccidity, & respiratory arrest

30
Q

concussion

A

Diffuse brain injury assoc w general or widespread neurological dysfxn
Temporary LOC (seconds to minutes to hrs)
Retrograde amnesia/Anterograde amnesia
Cognitive abilities impaired s/t neuronal injury: twisted/ stretched

31
Q

contusion

A

Bruising of brain @ site of impact or distal (contra coup forces)
Freq: frontal/temporal lobes, or brain stem involved
Assoc w prolonged LOC
Implications: monitor closely for edema, ↑ ICP, possible herniation

32
Q

types of cerebral hematoma

A

epidural - arterial
– rapid deterioration/LOC + herniation

subdural - venous
– most common

intracranial - into parenchyma d/t direct trauma or shearing forces
– poor prognosis d/t assoc injuries

33
Q

epidural hematoma

A

Bleeding btw inner table & dura mater
Freq occurs w linear skull fracture
ARTERIAL BLEED: middle meningeal art, assoc w temporal/parietal injury

Rapid deterioration w LOC & herniation

34
Q

subdural hematoma

A

Bleed btw dura mater & arachnoid meninges
MOST COMMON - venous bleed
Assoc w other injuries (contusions)
sx r/t area of injury, degree ↑ ICP

35
Q

intracranial hematoma

A

Bleeding into brain parenchyma from direct injury or shearing of small vessels
MOI: trauma, GSW

Poor prog d/t assoc injuries (↑ mortality)

36
Q

migraine headache s/s

A

premonitory sx (aura), photophobia, N, V

37
Q

cluster headache s/s

A

ipsilateral lacrimation, rhinorrhea, ptosis, 30 - 180 min long

38
Q

migraine tx x3

A

sumatriptan (Imitrex)
midrin (non-opioid analgesic, has APAP in it, sympathomimetic)
rizatriptan (Maxalt)

39
Q

cluster headache tx

A

indomethacin (NSAID)

nifedipine, nimodipine

40
Q

ergots & triptans: nota bene!!

A

do not use these drug types within 24 hours of each other - serotonin syndrome risk!

(class: abortive migraine meds)

41
Q

visceral pain

A

organs, body cavities

C fibers

42
Q

somatic pain

A

alpha & delta fibers

body tissue injury: skin, SQ tissue, bones, blood vessels, muscles

43
Q

neuropathic pain

A

d/t primary lesion in nervous system sustained by aberrant somatosensory processing in PNS or CNS - not related to nociceptor stimulation

central (ex: phantom limb) vs peripheral (ex: neuralgia)

44
Q

cancer pain treatment steps x3

A
  1. mild: non-opioid analgesics
  2. moderate pain or no relief from #1 - opioids (codeine or hydrocodone), hydrocodone w APAP, or lortab adjuvant
  3. severe or no relief from #2:
    - morphine, hydromorphone, methadone, fentanyl, oxycodone
    - combo w non-opioid or h
45
Q

short acting opioids WHO Step 1 or 2

A

codeine
hydrocodone
oxycodone

46
Q

short acting opioids WHO Step 2 or 3

A

morphine (IR)
hydromorphone (Dilaudid)
oxycodone

47
Q

long acting opioids

A

MS Contin
Fentanyl
Methadone

48
Q

no ceiling dosage for?

A

MS

monster management (29 decks)

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