Neurologic Emergencies Flashcards
What is the Monro-Kellie Doctrine?
80% Brain
10% Blood
10% CSF
Intracranial Pressure
Normal ICP: 5-15 mmHg
Herniation
Risk if ICP >20 longer than 5 mins
MAP Equation
Diastolic + 1/3 (Systolic - Diastolic )
Cerebral Perfusion Pressure
CPP = MAP - ICP
Optic Ultrasound
Monitors ICP by measuring optic nerve diameter
SjVO2
Fiber optic catheters placed into IJ to measure cerebral oxygen supply, perfusion, and consumption.
PbtiO2
brain tissue oxygenation monitoring, electrode placed on at-risk tissue
Intracerebral Microdialysis
Pulls minute amount of blood out to measure brain neurochemistry
Penumbra
Area surrounding the dead tissue is hypoxic, irritated, and is salvageable
Ischemic Stroke: BP Management
Systolic: 140-160
Diastolic: 70-90
<180/105 before, during and 24hrs after tPA
tPA
Tissue Plasminogen Activator
-0.9 mg/kg max 90mg
-10% over 1 minute, 90% over 60 minute transfusion
TNK
Tenecteplase
- Cheaper than tPA
- More favorable
- Given in a single bolus
Subarachnoid Hemorrhage
SAH
“Worst headache of life”
“Thunderclap”
Starfish sign on CT
AEIOU TIPS
Acidosis
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psychosis
Seizures
Glasgow Coma Scale
Eye opening (1-4)
Verbal responsiveness (1-5)
Motor function (1-6)
Delirium
“Acute brain failure”
GCS Eye Opening
4-Spontaneous
3-To sound
2- To pressure
1-None
GCS Speech
5-Oriented
4-Confused
3-Words
2-Sounds
1-None
GCS Motor Function
6-Obeys commands
5-Localized
4-Normal flexion
3-Abnormal Flexion
2-Extension
1-None
Contraindications for thrombolytics
History of hemorrhagic stroke
CVA last 13 months
SBP >180
Pregnant or 1 month postpartum
Lung development unable to sustain life at
<23 weeks gestation or < 1lb fetal weight
Full term neonatal tidal volume
5-7 mL/kg
PEEP in neonate
4-6 cmH20
CPAP
First line vent support in neonates
4-6 PEEP
30 - 100% FiO2
Surfactant Administration
3 mL/kg
Meconium Aspiration Syndrome
Presents with:
- Atelectasis
- Persistent Pulmonary Hypertension (PPH)
- Pneumothorax
- Pneumothorax
Meconium Aspiration Syndrome treatment
Monitor for resp distress, treat with PPV, high PEEP, or surfactant
Respiratory Distress Syndrome (RDS)
Surfactant deficiency related to preterm delivery
 Decrees compliance
Atelectasis
V/Q mismatch
Tachypnea
Increased work of breathing
Ground glass chest radiography
Respiratory distress syndrome
Treatment
Oxygen administration
CPAP 6–8 cmH20
Intubation, mechanical ventilation
IV. Fluids.
IV antibiotics

Gastroschisis
Herniation of abdominal contents through abdominal wall
- Usually on right side of umbilicus
Gastroschisis treatment
Treat like abdominal evisceration
Omphalocele
Protrusion of viscera attached to the umbilical cord 
Treatment: treat like abdominal evisceration 
Congenital diaphragmatic hernia
Diaphragm fails to close during prenatal development, abdominal contents present in and thorax 
- scaphoid abdomen
- Bowel sounds over chest 
Intestinal Malrotation and Volvulus
Malrotation: twisting of small bowel over on his self, resulting in obstruction
Volvulus: strangulation about from malrotation what’s on
Normal CPP
50-90
Cranial Nerve I
Olfactory
Smell
Cranial Nerve II
Optic nerve
Vision
Cranial nerve 3
Oculomotor nerve
Eye movement, pupil constriction
Cranial Nerve IV
Trochlear nerve Eye movement
Cranial nerve V
Trigeminal nerve
Somatosensory information (touch, pain) from the face and head; muscles for chewing.
Cranial nerve VI
Abducens Nerve
Eye movement
Cranial nerve VII
Facial Nerve
Taste (anterior 2/3 of tongue); somatosensory information from ear; controls muscles used in facial expression.
Cranial Nerve VIII
Vestibulocochlear Nerve
Hearing, balance
Cranial Nerve IX
Glossopharyngeal Nerve
Taste (posterior 1/3 of tongue); Somatosensory information from tongue, tonsil, pharynx; controls some muscles used in swallowing.
Cranial Nerve X
Vagus Nerve
Sensory, motor and autonomic functions of viscera (glands, digestion, heart rate)
Cranial Nerve XI
Spinal Accessory Nerve
Controls muscles used in head movement
Cranial Nerve XII
Hypoglossal Nerve
Controls muscles of tongue
