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EM/Surg > Neuro Emergencies (Exam #3) > Flashcards

Neuro Emergencies (Exam #3) Flashcards

1
Q

What is considered increased ICP?

A

15+ mmHg

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2
Q

What two sxs may be seen with increased ICP? What triad may be seen as a late finding?

A
  • HA
  • N/V

LATE = Cushing’s Triad (bradycardia, HTN, respiratory depression)

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3
Q

What are the two primary tx for increased ICP? What monitoring is the gold standard?

A
  • O2
  • Mannitol

May need intraventricular monitoring

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4
Q

What type of skull fracture involves a single fracture?

A

Linear Skull Fracture

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5
Q

What type of skull fracture often involves NO neuro sxs?

A

Linear Skull Fracture

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6
Q

What is the recommended tx for a Linear Skull Fracture (2)?

A
  • Observe for 4-6 hours if NO neuro sxs and normal CT

- ADMIT/observe if suspected brain injury

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7
Q

What type of skull fracture often involves a brain parenchyma injury?

A

Depressed Skull Fracture

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8
Q

What is the recommended tx for a Depressed Skull Fracture (3)?

A
  • ADMIT
  • Td
  • Prophylactic abx
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9
Q

What two signs are often seen with a Basilar Skull Fracture?

A
  • Battle sign

- Raccoon eyes

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10
Q

What is the recommended tx for a Basilar Skull Fracture?

A

ADMIT ALL for observation

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11
Q

What is the recommended dx for a Penetrating Injury Skull Fracture?

A

EMERGENT CT without contrast

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12
Q

What is the recommended tx for a Penetrating Injury Skull Fracture (2)?

A
  • IMMEDIATE NS CONSULT

- IV abx

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13
Q

When would a disposition of home be considered for a brain contusion (4)?

A

ALL MET…

  • GCS of 15
  • Normal PE and CT scan
  • NO bleed
  • Good home monitoring available
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14
Q

What condition involves shearing of white matter secondary to blunt trauma? What is seen on CT scan (2)?

A

Diffuse Axonal Injury (DAI)

  • Blurred grey/white matter margins
  • Small lesions in white motor tracts
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15
Q

What layers are affected with an Epidural Hematoma? What type of blood is involved, and vessel(s) specifically?

A

Skull and dura

- ARTERIAL = Middle Meningeal a.

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16
Q

What layers are affected with an Subdural Hematoma? What type of blood is involved, and vessel(s) specifically?

A

Dura and arachnoid

- VENOUS = bridging veins

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17
Q

What condition involves a “lucid interval”?

A

Epidural Hematoma

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18
Q

What condition involves a lens-shape on CT?

A

Epidural Hematoma

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19
Q

What condition involves a crescent-shape on CT?

A

Subdural Hematoma

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20
Q

What condition involves a bleed in the CSF, and what is the most common cause?

A 
Subarachnoid Hemorrhage (SAH)
- Aneurysm
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21
Q

What are the two ways by which a Subarachnoid Hemorrhage (SAH) presents?

A
  • WHOL

- Thunderclap HA (TCH)

22
Q

What is the dx criteria used for Subarachnoid Hemorrhage (SAH), and what are the six components?

A

Ottawa SAH Rule = CT before LP

  • 40+ years
  • Neck pain/stiffness
  • Limited neck flexion
  • Witnessed LOC
  • Onset during exertion
  • Thunderclap HA (TCH)
23
Q

What dx test is ALWAYS required for a Subarachnoid Hemorrhage (SAH)?

A

LP

24
Q

What complication should especially be avoided with Subarachnoid Hemorrhage (SAH)?

A

Increased ICP

25
Q

What is the most common NON-trauma cause of an Intracranial Hemorrhage?

A

HTN

26
Q

What is the target BP in tx of a Intracranial Hemorrhage?

A

160-140/90

27
Q

Of the cerebral hemorrhages, which is considered an EMERGENCY?

This is dumb bc they’re all “emergencies”…

A

Intracranial Hemorrhage

28
Q

What SC injury is considered an EMERGENCY?

A

Cauda Equina Syndrome

29
Q

When would IV thrombolytics be considered for an Ischemic CVA?

A

If sxs onset is <4.5 hours

30
Q

What is the target BP in order to use IV thrombolytics in the tx of an Ischemic CVA?

A

<185/<110

31
Q

What are the two definitions of Status Epilepticus?

A
  • Continuous for 5+ minutes

- 2+ seizures with incomplete recovery

32
Q

What two classes of medications can be considered in the tx of Status Epilepticus, and what are examples of each (2, 3)?

A
  • Benzos = Lorazepam, Diazepam

- Anticonvulsants = Phosphenytoin, Levetiracetam, Valproate

33
Q

What are the two Benzos that can be used in the tx of Status Epilepticus?

A
  • Lorazepam

- Diazepam

34
Q

What are the three anticonvulsants that can be used in the tx of Status Epilepticus?

A
  • Phosphenytoin
  • Levetiracetam
  • Valproate
35
Q

If seizures continue after tx with Benzos and anticonvulsants for Status Epilepticus, what three meds should be considered?

A
  • IV Midazolam
  • IV Propofol
  • IV Pentobarbital
36
Q

What spine level is a Jefferson fracture seen, and what part of the vertebra is affected?

A

C1/Atlas

- Ant. or post. arches of C1

37
Q

What are the two types of fractures seen at the C2/Axis level, and what is another name for each?

A
  • Pedicle (Hangman’s)

- Odontoid (Dens)

38
Q

Which two Types of Odontoid (Dens) fracture are unstable?

A
  • Type II

- Type III

39
Q

With what type of spinal cord fracture is spinal cord damage minimal, and why?

A

Pedicle (Hangman’s)

- C2 has the greatest AP diameter

40
Q

What type of spinal cord fracture is displaced in all directions, and what general area is this typically seen?

A

Burst Fracture

- Lower C spine

41
Q

What type of shock can develop from Spinal Cord Injuries?

A

Neurogenic shock

42
Q

What are the two timings of symptom presentations in COMPLETE Spinal Cord Injury, and what specific sxs are seen with each?

A
  • <1 day = absent reflexes, flaccid

- 1-3 days = hyperreflexia, spastic, + Babinski’s

43
Q

What are the four types of INCOMPLETE Spinal Cord Injuries?

A
  • Anterior (Ventral)
  • Central
  • Posterior (Dorsal)
  • Brown Sequard = one sided
44
Q

Which type of INCOMPLETE Spinal Cord Injury presents with bilateral pain/temperature loss and bladder dysfunction?

A

Anterior (Ventral)

45
Q

Which type of INCOMPLETE Spinal Cord Injury presents with motor in UE > LE, DTRs lost?

A

Central

46
Q

Which type of INCOMPLETE Spinal Cord Injury presents with hyperreflexia, gait ataxia?

A

Posterior (Dorsal)

47
Q

Which type of INCOMPLETE Spinal Cord Injury presents with ipsilateral motor paralysis and proprioception/sensory loss AND contralateral pain/temperature loss?

A

Brown Sequard

48
Q

What two signs present with a Brown Sequard INCOMPLETE Spinal Cord Injury?

A
  • Ipsilateral motor paralysis and proprioception/sensory loss
  • Contralateral pain/temperature loss
49
Q

What is the recommended dx test for Cauda Equina Syndrome?

A

EMERGENT MRI with AND without contrast

50
Q

What is the recommended tx for Cauda Equina Syndrome?

A

Dexamethosone

51
Q

What condition presents with LBP radiating unilaterally, weakness and “saddle anesthesia”?

A

Cauda Equina Syndrome

EM/Surg (16 decks)

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