Neuro, renal, acid/base, fluids

Question 1

Mild Concussions are classified as what?

What are the 3 progressive types of mild concussion?

Answer 1

Temporary axonal disturbance causing attention and memory loss but NO LOSS OF CONSCIOUSNESS!

I Confusion, disorientation, and momentary amnesia

II Confusion and retrograde amnesia (few minutes)

III Confusion and both retrograde (>few minutes) and anterograde amnesia.

Anterograde amnesia: inability to form new memories

Question 2

What is a classic concussion and how is it classified?

Answer 2

Classified Grade IV:

1) loss of consciousness (<6 hrs)
2) Disconnection of cerebral systems from the brain stem and reticular activating system (regulates arousal).
3) Physiologic and neurologic dysfunction without substantial anatomic disruption
4) Anterograde and retrograde amnesia

Question 3

What are the 4 phases of spinal shock and what causes it?

Answer 3

Spinal shock is caused by a SCI most oftern a transection of the spinal cord.

Phase1: Loss of all reflexes below the site of injury (usually lasts a day; bladder, sexual functions)

Phase 2: Return of some relexes (few days)

Phase 3 and 4: Autonomic Hyperreflexia

Question 4

Where would you expect a spinal cord injury had occured in someone suffering from paraplegia, quadraplegia, or autonomic hyperreflexia?

Answer 4

Para: T1-L2

Quadra: C1,2,4-7

AutoHyper: T6 or above

Question 5

What are two major signs of autonomic hyperreflexia?

Answer 5

1) stimulation of the sensory receptors below the level of the cord injury (distended bladder)
2) Massive, cardiocascular response (bp up to 200mmHg) due to excess activation of sympathetic nervous system.

Reflexes don’t come back “Bill”

Question 6

Aneurysm