Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Final > Neuroanaesthesia > Flashcards

Neuroanaesthesia Flashcards

1
Q

Incidence of neurological damage during scoliosis correction

A

0.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SSEP stimulation electrodes placement

A

Pair of stimulating electrodes placed bilaterally:
1. Posterior tibial nerves (lumbar surgery)
2. Median nerves (cervical surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Frequency of SSEP stimulation

A

30mA at 5Hz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SSEP recording electrode placement

A

Proximal to site of surgery:
1. 2 or more scalp electrodes (frontal and cervical)
2, Reference electrode
3. Ground electrode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Band filter width for SSEP

A

20-1000 Hz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Shape of characteristic response in SSEP

A

W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Changes seen in SSEP with spinal cord compromise

A

Increased latency
Decreased amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Critical change in SSEP

A

50% increase in latency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is an MEP?

A

Motor Evoked Potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a SSEP?

A

Somatosensory Evoked Potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does MEP monitor?

A

Territory of the anterior spinal cord artery (corticospinal tracts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does SSEP monitor?

A

Ascending sensory pathways (dorsal columns)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Source of stimulation for MEP

A

Transcranial electrical stimulation Transcranial magnetic stimulation Direct rostral spine stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk of transcranial electrical stimulation

A

Injury secondary to mandibular contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are MEPs recorded?

A

SC / IM needle electrodes in arm and leg muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Time taken for MEP response

A

Less than 1 minute ???

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Latency of SSEP

A

20 ms upper limb
37 ms lower limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define Serious Traumatic Brain Injury

A

GCS < 9 post resuscitation → mortality 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List some primary prevention strategies for serious traumatic brain injury

A

Helmets
Airbags
Reducing alcohol consumption
Speed limits

20
Q

Define secondary brain injury

A

A hypoxic insult to the brain from oedema, haematoma or low systemic pressure following a primary insult

21
Q

Indications for CT head within 1 hour of TBI

A

GCS <13 at any time
GCS 13-14 2 hours post-injury
Open fracture
Skull base fracture
More than 1 episode of vomiting Seizure
Coagulopathy
Event amnesia
Focal deficit

22
Q

Oxygen targets in TBI

A

PaO₂ >13

23
Q

CO₂ targets in TBI

A

ETCO₂ 4.5-5

24
Q

MAP target in TBI

A

> 80

25
Q

Glucose targets in TBI

A

6-10 mmol/L

26
Q

Describe the features of diabetes insipidus

A

Raised sodium
Polyuria
Low urine osmolality

(Caused by lack of ADH / lack of response to ADH → polyuria + dehydration)

27
Q

CPP target in neuroprotection

A

> 60

28
Q

ICP target in neuroprotection

A

<20

29
Q

Rescue therapies in TBI

A

ABC
Ensure good venous drainage
Increase sedation
Hyperventillate to ETCO₂ 4-4.5
Hypertonic saline (1-3ml/kg 5%, 3-5ml/kg 3%) or mannitol (0.25-2g/kg)
Barbiturate coma (burst suppression)

30
Q

What causes the blown pupil in a decompensating head injury?

A

Falsely localising nerve injury (CN III) - due to uncal herniation → mechanical compression of CN III → subsequent brain stem compromise

31
Q

How should you treat seizures in TBI?

A

Thiopental or benzodiazepine immediately
Phenytoin or levetiracetam loading immediately afterwards

32
Q

The role of steroids in TBI

A

Generally none

33
Q

Why early fixation in unstable spinal injury?

A

Allows for proper nursing care, PT, cough etc.

34
Q

Classical timing for early complications of SAH

A

Day 1: hydrocephalus
Day 1-7: rebleed
Day 7+: ischaemia

35
Q

SAH risk factors (7)

A

Smoking
HTN
Alcohol
Polycystic kidney
Family history
Female gender
Age 40-50

36
Q

SAH incidence

A

6/100,000 patient years

37
Q

SAH outcomes

A

10% die before hospital
40% die within 1 month

38
Q

Modified Fisher Scoring System

A

Grade 0:

  • No SAH
  • No IVH

Grade 1:
- Focal or diffuse, thin SAH
- No IVH
- Incidence of symptomatic vasospasm: 24%

Grade 2:
- Focal or diffuse, thin SAH
- IVH present
- Incidence of symptomatic vasospasm: 33%

Grade 3:
- Thick SAH
- No IVH
- Incidence of symptomatic vasospasm: 33%

Grade 4:
- Thick SAH
- IVH present
- Incidence of symptomatic vasospasm: 40%

39
Q

Hunt and Hess Scoring System

A

Clinical grading system
Grade 1: asymptomatic/mild headache
Grade 2: moderate-severe headache or nuchal rigidity, or cranial nerve palsy
Grade 3: lethargy, confusion, or mild focal deficit
Grade 4: stupor and/or hemiparesis
Grade 5: deep coma, decerebrate posturing, or moribund appearance

40
Q

Modified WFNS Scoring System

A

Grade I: GCS 15
Grade II: GCS 14
Grade III: GCS 13
Grade IV: GCS 7-12
Grade V: GCS 3-6

41
Q

What are the hallmarks of a cholinergic crisis?

A

SLUDGE + other
Salivation
Lacrimation
Urination
Defecation
GI upset
Emesis
Miosis
Muscle weakness
Flaccid paralysis (initially spasm)
Respiratory failure

42
Q

What are the indications for urgent (within 1 hour) CT head?

A

GCS < 13 when first assessed in emergency department
GCS < 15 when assessed in emergency department 2 hours after the injury
Suspected open or depressed skull fracture
Sign of fracture at skull base haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from ears or nose,
Battle’s sign (bruise behind ear)
Post-traumatic seizure
Focal neurological deficit
> 1 episode of vomiting

43
Q

Cerebral ischaemia monitoring in CEA

A

Awake
Transcranial doppler
Stump pressure
EEG
SSEP
NIRS

44
Q

What are the diagnostic criteria for SIADH?

A

Hypotonic hyponatraemia
- Serum sodium <135 mmol/l
- Serum osmolality <280 mOsm/kg
Urine osmolality > serum osmolality
Urine sodium concentration >18 mmol/l
Normal thyroid, adrenal, and renal function
Clinical euvolaemia - absence of peripheral oedema or dehydration

45
Q

How do you treat SIADH?

A

Conservatively
Fluid restrict (1000mL/day)
Hypertonic saline (1.8%) if Na <120 mmol/L
Consider diuretics (furosemide)
Consider demeclocycline (inhibits ADH)

46
Q

Cerebral Salt Wasting Syndrome biochemical diagnostic criteria

A

Low/normal serum sodium;
High/normal serum osmolality;
High/normal urine osmolality
High urine sodium
Increased haematocrit/urea/bicarbonate/albumin as a consequence of hypovolaemia

47
Q
A

Final (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions