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7364 Critical Care Block 3 > Neurocritical Care > Flashcards

Neurocritical Care Flashcards

1
Q

___ is usually caused from saccular aneurysm

a. hypertensive intracerebral hemorrhage (ICH)
b. subarachnoid hemorrhage

A

b. subarachnoid hemorrhage

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2
Q

Two types of subarachnoid hemorrhage?

A

hypertensive

aneurysmal

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3
Q

The largest two risk factors for aneurysmal SAH?

A

cigarette smoking

HTN

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4
Q

Which type of hypertensive intracranial hemorrhage causes total paralysis?

A

pontine

pinpoint pupils ocular bobbing

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5
Q

Cushing’s reflex is a sign of what?

A

herniation

increased pulse pressure
bradycardia
irregular breathing

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6
Q

Normal mean arterial pressure (MAP)?

A

70-105mmHg

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7
Q

Normal intracranial pressure (ICP)?

A

7-15mmHg

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8
Q

Hypertensive ICH SBP goal is < __ mmHg

A

140

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9
Q

Aneurysmal SAH SBP goal is < ___ mmHg

A

160

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10
Q

Which has more rapid onset, labetalol or hydralazine?

A

labetalol

5 mins vs 5-15mins

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11
Q

Dose stacking can occur with which acute BP reduction drug?

A

hydralazine

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12
Q

4 drugs for acute BP reduction?

A

hydralazine
labetalol
nicardipine
clevidipine

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13
Q

For pts on anticoagulants who develop any type of intracranial hemorrhage (ICH), when should anticoagulants be restarted?

A

2-4 weeks after stabilization of ICH

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14
Q

If antifibrinolytic therapy is started for aneurysm antifibrinolytic therapy should not continue past __ hours

A

72

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15
Q

What calcium channel blocker is used to decrease complications associated with vasospasm?

A

nimodipine

lipophilic DHP CCB

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16
Q

Hypertensive intracranial hemorrhage VTE prophylaxis should be started within _ to _ hours of a stable head CT

A

24, 72

17
Q

VTE prophylaxis with aneurysmal subarachnoid hemorrhage should begin within __ ours after SAH secured

A

24

18
Q

A 64 year old female presents with a sudden onset headache. (worst of her life). Upon CT head imaging it is determined she has an aneurysmal SAH. Which of the following meds should be started to decrease potential complications from delayed cerebral ischemia?

a. nicardipine
b. tranexamic acid
c. enoxaparin
d. nimodipine

A

d. nimodipine

19
Q

what is main drug for hyperosmolar therapy?

A

mannitol

20
Q

Serum osmolality should be. kept below ___ mOsm/kg

A

320

21
Q

Hypertonic saline for TBI should be filtered

a. true
b. false

A

b. false

mannitol should be filtered, but hypertonic saline does not have to be

22
Q

Which paralytic is useful in TBI b/c it can be given without regard to liver or kidneys?

A

cisatracurium

23
Q

What is recommended Tx for VTE prophylaxis in TBI pts?

a. LMWH or subQ UFH
b. mechanical prophylaxis
c. both

A

c. both

can start within 24hrs of a stable CT head scan

24
Q

What is the only drug that has been shown to decrease early post traumatic seizures (PTS)?

A

phenytoin

25
Q

Evidence shows an increase in mortality with TBI when what steroid is used?

A

methylprednisolone

corticosteroids should not be used post TBI unless needed for another indication

26
Q

Seizure prophylaxis with phenytoin or levetiracetam may reduce complications associated with __ post-traumatic seizures

a. early
b. late

A

a. early

27
Q

Glasgow coma scale score of ___ indicates severe brain injury

A

3-8

28
Q

Glasgow coma scale score of _ indicates moderate brain injury

A

9-12

29
Q

Glasgow coma scale score of __ indicates minor brain injury

A

13-15

30
Q

What is goal systolic blood pressure for TBI in pts age 50-69?

A

> 100mmHg

31
Q

What is goal systolic BP for TBI in pts age 15-49 and 70+?

A

> 110mmHg

32
Q

What is recommended target cerebral perfusion pressure for TBI?

A

60-70mmHg

avoid aggressively attempting to increase CPP > 70mmHg

33
Q

Initiate medical treatment for TBI at what intracranial pressure?

A

> 22mmHg

34
Q

Guidelines recommend a MAP of ___ mmHg for 7 days following spinal cord injury

A

> 85-90

use vasopressors if needed

35
Q

Complications of spinal cord injury:

Unopposed vagal tone often leads to severe cardiac arrhythmias including ___

A

bradycardia

and rarely supraventricualr tachycardia or ventricular tachycardia

7364 Critical Care Block 3 (6 decks)

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