Neuro ICU Flashcards
1
Q
indications for admission to ICU
A
- threatened airway
- all respiratory arrests
- respiratory rate >40 or <90 on >50% oxygen
- all cardiac arrests
- pulse rate <40 or >140 bpm
- SBP <90 mmHg
- sudden fall in level of consciousness (fall in Glasgow coma score >2 points)
- repeated or prolonged seizures
- rising arterial CO2 tension with respiratory acidosis
- any pt giving cause for concern
2
Q
Neuro Dx leading to ICU admission
A
- CVA
- GBS
- Acquired TBI
- Acquired SCI
- MG
- Seizures
- Brain tumors
- Hydrocephalus
3
Q
ICU Chart Review
A
- MD POC
- Diagnostic Imaging
- Lab Values
- Meds
- Current Pt Status
- Lines, Drains, Tubes
4
Q
Neurosurgery vs Neurology Team
A
- NSGY
- consulted whenever dx may warrant invasive interventions for the brain or spinal cord
- also orthopedic injuries to the spine
- consulted whenever dx may warrant invasive interventions for the brain or spinal cord
- Neuro
- primary team when invasive interventions not warranted and/or when pt demos sig fluctuations in neuro status
5
Q
Trauma vs Ortho team
A
- Trauma
- primary team admitting dx is a result of trauma
- can be involved in surgical interventions
- Ortho
- consulted whenever orthopedic injury to extremities
- can be involved in surgical interventions
6
Q
major search points for reviewing prior MD notes and active orders
A
- Reason for admission to ICU
- PMHx and relevant interventions
- HPI and relevant interventions
- 24-hour plan
- Precautions
7
Q
Lab Values CBC
A
- should be relatively stable, with some considerations for admitting dx
- ex → hemorrhage → decreased hgb/hct, increased platelets
- if not further up/downward, usually okay to see
- check with RN or POC (transfusion, etc.)
8
Q
Lab Values: Electrolyte Panel
A
- Patients are very symptomatically sensitive to changes in Na after a neurological event
- cognitive changes
- Sig changes in Cl, Ca, Mg, PO4 and K are less common post neurological insult
9
Q
Lab Values: Kidney Function
A
- BUN and serum creatinine generally stable unless relevant comorbidities present
- if complications seen, tends to be more subacute/chronic stages recovery
10
Q
Lab Values: Endocrine Function
A
- Helpful to review blood glucose prior to mobilization, common to see fluctuations
- hyper and hypoglycemia both lead to poor activity tolerance
11
Q
Lab Values: Thyroid Function
A
- Hypothyroidism → has been associated with signs of aortic or coronary atherosclerosis
- slowed cog function, ataxia, weakness, paresthesia, edema, bradycardia, CHF, HTN
- Hyperthyroidism → associated with atrial fibrillation and cardioembolic stroke
- tremors, weakness/atrophy, tachycardia, arrhythmias, hypotension
12
Q
Lab Values: Acid-Base Disorders
A
- Respiratory Alkalosis common sequelae of CVA
- dizziness, paresthesias, chest pain, confusion, seizures
- Respiratory Acidosis common with prolonged ventilatory support and neuromuscular disease
- confusion, fatigue/somnolence, SOB
13
Q
Arousal, Cognition, Behavior Outcome Scales
A
- GCS (Glascow Coma Scale)
- CRS-R (Coma Recovery Scale)
- ABS (Agitated Behavior Scale)
- RASS (Richmond Agitation and Sedation Scale)
- CAM (Confusion Assessment Method)
- RN Assessment - Delirium
14
Q
green light status for the RASS
A
- +1 (restless)
- 0 (alert and calm)
- -1 (drowsy)
- -2 (light sedation)
15
Q
yellow light status for RASS
A
- +2 (agitated)
- -3 (moderated sedation)
16
Q
red light status for RASS
A
- +4 (combative)
- +3 (very agitated)
- -4 (deep sedation)
- -5 (unarouable)
17
Q
common medications for agitation and whether you should treat them if they are on it
A
- propofol → red light do not treat, huge sedative
- fentanyl → yellow light, strong sedative and pain killer
- precedex → green light, mild sedative