Neuro Etsy Flashcards
To lower ICP
Mannitol
3%
Lasix
Upright position
Things to avoid with increased ICP
no hypotonic fluids
No restraints
No pain/agitation (use PROPofol)
No acidosis (vasodilator)
PROPOFOL
is used with increased ICP to prevent agitation/pain
Which type of brain bleed develops fast? Which one develops slower?
Fast-epidural
Slow-subdural
Seizures can cause
Rhabdyomyolosis
Arrhythmias
Hypoglycemia
Hyper K
Seizure death is actually
Death by cerebral hyper metabolism
Early manifestation of brain tumors
Seizures
Steroid therapy in brain tumors helps to:
Prevent increased ICP
Etiology of encephalopathy
Metabolic
Hypoxia
Hepatic
Infection
Drugs
Encephalopathy s/s
****increased ICP****
Slow cognition
Personality changes
Memory loss
Agitation
Seizure>coma>brain death
notice that pupil changes is not a symptom
Encephalopathy tx
Identify and treat cause
Prevent ^ ICP
keep patient safe by (no hypotonic, no flat HOB, no restraint(
What does acidosis do to ICP? Why?
Increases ICP r/t vasodilation
CSF normals
Glucose 60%
Protein 20-45
LP pressure 80-180
Bacterial v. viral Meningitis
Bacterial: glucose low (<60%)
Viral: glucose normal (60%)
Bacterial Meningitis
CSF with:
HIGH: protein, LP pressure, WBC’s
NORMAL:
LOW: glucose
PURLENT COLOR
TX: ABX
Viral Meningitis
CSF with:
HIGH: protein, WBC’s
NORMAL: glucose & LP pressure
LOW:
CLEAR COLOR
S/S MENINGITIS
- HA
- nuchal rigidity
- BUDZINSKI’s sign (neck stiffness with knee/hips to flexed neck
- KERNIG sign (hamstring stiffness & neck pain with 90’ hip flexion
BUDZINSKI’s sign
neck stiffness with knee/hips to flexed neck
SIGN OF MENINGITIS
KERNIG’s sign
hamstring stiffness & neck pain with 90’ hip flexion
SX of MENINGITIS
is used with increased ICP to prevent agitation/pain
PROPOFOL
is there a change in LOC
Guillain-Barré syndrome
- Viral Ascending paralysis
- NO CHANGE IN LOC
- diaphragm > resp failure
- Monitor: resp, UOP,
- Tx: steroids, plasmapherisis, IVIG (immunoglobulin)
whats that one treatment that i keep forgetting?
Myasthenia Gravis
- Auto immune - progressive skeletal muscle weakness and paralysis
- early onset = fatigue,
- Late onset = paralysis
- TX: steroids, plasmapherisis, IVIG, pyridostigmine(cholinestrase inhibitor), thymus gland removal
- myasthenia crisis
- TENSILON test
- cholinergic crisis
Myasthenic Crisis
- caused by excess of acetylcholine
- tensilon test (pt improves)
Cholinergic crisis
- caused by excess of acetylcholine
- tensilon test (pt does not improve)
- increased muscle weakness, lacrimation, salvation and GI distress
Tensilon test
a diagnostic test used to evaluate myasthenia gravis,
positive *** if their muscles get stronger after being injected with Tensilon.
two terms relating to muscle problems Which type of MD is at risk for malignant hyperthermia?
Muscular Dystrophy
- inherited genetic disorder
- starts at trunk and spreads, legs before arms
- myopathy = progressive muscle weakness
- atrophy = progessive loss of muscle mass
- types:
- Duchenne
- Becker
Duchenne MD
EARLY onset
- death in late teens
- d/t cardiomyopathy / resp infections
Becker MD
LATE onset
- death in 40s
- d/t HF
- Tx: steroids, CPAP, vaccine, baseline PFT, monitor HF, ACE/ARB’s,
- high risk – malignant hyperthermia
Brain death
complete, irreversible cessation of function of cerebrum, cerebellum, & brainstem
Before confirmation of brain death, must confirm: (7)
coma irreversible, known cause
imaging confirms coma
No paralytics or CNS depressants
absence of severe acid-base imbalance
normal body temp / mild hypo
SBP >100
no spontaneous respirations
Clinical examination of Brain death
- ABSENT pupillary response, corneal reflex, gag, cough, motor response in all 4 extremities
- apnea test, determines BD at bedside
- cerebral angiograms, EEG, transcranial u/s
- REFLEX testing:
- (absent) dolls eyes
- (absence) cold caloric test
abse
TWO openings in skull
Transtentorial shelf / notch (small)
Foramen magnum (large)
Broca’s area
controlls speech
located on L
expressive / receptive aphasia
Decorticate
Flexed arms
hemispheric dysfunction
Decerbrate
straight / extention of arms
midbrain / pons
WORSE outcome
Dolls eyes (reflex)
Positive = eyes turn opposite of where head is turned
Positive = GOOD
Cold Caloric Test
ice water > ear canal
positive = eyes toward ear with ice water injection
Positive = GOOD
CN ????
Homonymous hemianopia
- loss of vision in half field of both eyes
- Damage to CN II
- Opposite (contralateral) side of problem
Babinski’s Reflex
Toes flair up and out when foot bottom stroked
opposite (contralateral) side of problem
Reversal agent for BENZOS
ROMAZICON
1st sign of neuro problem
LOC / AMS
when is pupil changes the first sign
Epidural Hemotoma
eyes deviate (towards or away) from problem
towards
Cranial nerves
- I. Olfactory (smell)
- II. Optic (sight)
- III. Oculomotor (pupillary function)
- VIII. Vestibulocochlear (process of hearing & balance
- *****all except I & II originate from brain stem***
define obtunded and stuporus
GCS
best answer
15 = best
<8 poor prognisis
Obtunded = CAN speak, mumbles
Stuporus = CAN NOT speak; moans/grimaces
TBI
severity based on GCS
3-8 SEVERE
9-12 MODERATE
13-15 MILD
SKULL FX
LINEAR - no surgery
DEPRESSED - surgery if > 5mm
BASILAR - surgery if CSF leakage persistent
Basilar skull fracture
- causes meningeal tear
- Risk of developing MENINGITIS
- S/S
- raccoon eyes
- battles sign (bruise behind ears)
- otorrhea (CSF from ear)
- rhinorrhea (CSF from nose)
- CN I damage (loss of smell)
- TX: Check for CSF
CSF care
CSF leakage frequent in basilar skull fx
- cover ear or nose with dry sterile gauze (no packing)
- NO NGT - use OG
- DO NOT blow nose
- CSF is + for glucose
- Halo sign (yellow halo surrounding clot)
cushings triad
****sign of brain herniation****
⬆️ SBP
⬇️ HR
⬇️ RR
Central brain Herniation
Slower
Downward shift
1st sign LOC
+ Babinski bilat
Uncal Brain Herniation
swelling on one side of brain
Rapid
Lateral shift
1st sign Pupils > LOC
+ Babinski opposite side
Neuro problems that cause a Pupil change as first sign
Unical brain herniation
Epidural Hemotoma
