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Principles 4 > Neurologic monitoring PPT-josh > Flashcards

Neurologic monitoring PPT-josh Flashcards

1
Q

Know where the common/internal.external Carotids arise:

where does the common arise from

A
  • Arotic arch (2nd take off)
  • innominant artery
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2
Q

Know where the common/internal.external Carotids arise:

what take off is first when traveling the common carotid, the external or internal?

A
  • external
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3
Q

Know where the common/internal.external Carotids arise:

what is the last take off when traveling the common carotid, teh external or internal?

A
  • internal (you could have got this via process of elimination of the last 2 cards, but good job anyways)
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4
Q

what suppies the cerebral blood supply

A

Circle of willis

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5
Q

Lable this

A
  1. Internal Carotid
  2. External carotid
  3. Common Carotid
  4. Brachiocephalic
  5. Subclavian
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6
Q

Ok so I was a little confused!!! Basically about all the take offs and where the actual comon carotids arise from!!!

So i went searching and this is what i came up with! I will ask the question then give the answers!!!!

Explain the Aortic arch and takoffs from start and finish with the internal carotids!!!

A
  1. Ascending arch
  2. innominant artery
  3. brachiocephalic (or right subclavian) and Right common carotid
  4. Rght common carotid divides into right external carotid
  5. then right common carotid divides into the right internal carotid
  6. Next take off on arch is the left common carotid
  7. The left common carotid divides into the left external carotid
  8. then the left common carotid divides into the left internal carotid
  9. the last take off of arch is the Left subclavian

I hope that helps!! her diagram sucks ass!!!

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7
Q

here is a pic

A
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8
Q

What are 4 NON-invasive monitors for cerebral blood flow

A
  1. Intavascular tracer compounds
  2. Jugular bulb Venous O2 Sat
  3. Transcranial doppler US
  4. Cerebral Oximetry
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9
Q

Non-invasive CBF monitoring: IV tracer compounds

this allows direct measurement of what?

A

CBF

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10
Q

Non-invasive CBF monitoring: IV tracer compounds

Determines kinetics of wash-in and/or wash-out of an inert tracer compound (usually radioactive isotope of what)

A

Xenon

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11
Q

Non-invasive CBF monitoring: IV tracer compounds

so in a laymen’s or josh terms what the fuck is this?

A
  • You shoot some IV shit usually xenon into the IV and measure somehow how it goes in and out
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12
Q

Non-invasive CBF monitoring: IV tracer compounds

________ detectors over specific brain areas measure radioactivity

A

Gamma

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13
Q

Non-invasive CBF monitoring: IV tracer compounds

what are some of the draw backs of this method?

A
  • Exposure to radioactivity
  • Cumbersome
  • Focal ischemic area may be missed
  • Just give a “snapshot” of CBF
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14
Q

Non-invasive CBF monitoring: Jugular bulb Venous O2 Saturation

Measure the _______ extraction of the brain

A

Oxygen

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15
Q

Non-invasive CBF monitoring: Jugular bulb Venous O2 Saturation

Requires retrograde placement of a fiberoptic probe in the ____ ______ using flouro

A

Jugular bulb

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16
Q

Non-invasive CBF monitoring: Jugular bulb Venous O2 Saturation

do the right and left jugular bulbs drain the same or different regions?

A

Different

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17
Q

Non-invasive CBF monitoring: Jugular bulb Venous O2 Saturation

it is only considered a measurement of ______ cerebral oxygenation

A

Global

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18
Q

Non-invasive CBF monitoring: Jugular bulb Venous O2 Saturation

In josh terms what the hell is this test

A
  • measures the heads cerebral O2 use, by sticking a prob in the jugular bulbs w/ flouro
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19
Q

Non-invasive CBF monitoring: transcranial doppler US

it is an inference of CBF by measuring blood flow ______ in large arteries to the brain

A

Velocity

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20
Q

Non-invasive CBF monitoring: transcranial doppler US

Often times it uses continuous measurment of flow through the ____ ____ Artery

A

Middle cerebral artery

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21
Q

Non-invasive CBF monitoring: transcranial doppler US

besides juust flow it can also alert tot he presence of what?

A
  • particulate emboli
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22
Q

Non-invasive CBF monitoring: transcranial doppler US

the particulate emboli will appear as a high density transient signals and a _____ in the background sounds

A

Chirp

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23
Q

Non-invasive CBF monitoring: transcranial doppler US

this measurement assumed to work b/c it is thought that blood flow velocity is directly r/t ____ _____ only if the diameter of the vessel is measured and Doppler probe is constant

A

Blood Flow

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24
Q

Non-invasive CBF monitoring: transcranial doppler US

should this be used as the sole monitor of CBF

A

Nope

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25
Q

Non-invasive CBF monitoring: transcranial doppler US

what the fuck is this is Josh terms?

A
  • They stick a US probe on your head, measure the velocity of the blood flow through the middle of your head (middle cerebral artery)
  • If you hear a chirp then you have clots
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26
Q

Non-invasive CBF monitoring:

what is the most frequently used method?

A

Cerebral Oximetry

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27
Q

Non-invasive CBF monitoring: Cerebral Oximetry

Measures O2 sat of tissues under 2 sensors placed where?

A

On both sides of forehead

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28
Q

Non-invasive CBF monitoring: Cerebral Oximetry

measures local _____ _____ saturation?

A

Venous oxygen

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29
Q

Non-invasive CBF monitoring: Cerebral Oximetry

it measures local venous o2 saturation b/c _/_ to _/_ of cerebral blood volume is venous

A

2/3

to

4/5

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30
Q

Non-invasive CBF monitoring: Cerebral Oximetry

it is assumed to be accurate b/c is the face of cerebral ischemia, cerebral oximetry will decrease so to what?

A

increased O2 extraction

31
Q

Non-invasive CBF monitoring: Cerebral Oximetry

Sensore should be placed when? and why?

A
  • preop
  • to establish a baseline correlated with neuro exam
32
Q

Non-invasive CBF monitoring: Cerebral Oximetry

a decrease of >___% indicated inadequate cerebral perfusion

33
Q

What are 2 Invasive tech for monitoring CBF?

A
  1. Thermal diffusion CBF monitoring
  2. Tissue partial pressure of O2 monitoring
34
Q

Invasive techniques for CBF monitoring: Thermal Diffusion

Heat dissipates in a tissue dependent on the tissue’s thermal conductive properties (constant) and the blood flow in that area (variable)

A

No question way to retarded to ask

35
Q

Invasive techniques for CBF monitoring: Thermal Diffusion

a probe with a thin catheter containing __ thermistors (5cm apart) are placed in the subcortical white matter

36
Q

Invasive techniques for CBF monitoring: Thermal Diffusion

what does the proximal thermistor do?

A

Measures brain temp

37
Q

Invasive techniques for CBF monitoring: Thermal Diffusion

what does the distal thermistor do?

A

heated 2 C higher than brain temp

38
Q

Invasive techniques for CBF monitoring: Thermal Diffusion

the power to sustain the temp is directly proportional to what?

A

Blood flow

39
Q

Invasive techniques for CBF monitoring: Thermal Diffusion

what the fuck is it in josh terms

A
  • 2 probes the proximal one measures temp
  • the distal one heats up 2 c higher than teh brain
  • it only stays heated if there is blood flow
40
Q

Invasive techniques for CBF monitoring: Tissue Partial Pressure

gives a good correlation b/t tissue O2 levels and ____

41
Q

Invasive techniques for CBF monitoring: Tissue Partial Pressure

how does it work?

A
  • Diffusion of O2 molecules through an O2 permeable membrane into an electrolyte solution, produces a electrical current proportional to O2
42
Q

Invasive techniques for CBF monitoring: Tissue Partial Pressure

this probe is placed in subcortical white matter and stable over ____ periods of time

43
Q

Invasive techniques for CBF monitoring: Tissue Partial Pressure

what the fuck is it??? Please josh tell me!!!

A
  • Stick a probe in brain (white mater) measure the O2 crossing it
  • Produces an electricity!!
  • Can stay in place for a while
44
Q

Monitors of Nervous System Function:

what are the 4 main monitors?

A
  1. Sensory evoked potential (EPs)
  2. Electroencephalogram
  3. Motor evoked potentials
  4. BIS
45
Q

Monitors of Nervous System Function:

do you need to place the BIS prior to induction?

A

Nope!! You don’t need a baseline

46
Q

Monitors of Nervous System Function:

Bis score 70-80

A
  • Moderate sedation
47
Q

Monitors of Nervous System Function:

BIS score 40-60

A
  • General anesthesia
48
Q

Monitors of Nervous System Function:

BIS score below 60

A
  • Amnesia/ no recall

(i thought it was 70 but in class she said 60)

49
Q

Monitors of Nervous System Function:

which monitoring system identifies consciousness, unconsciousness, sz activity, stages of sleep, and coma

A
  • Electroencephalogram (ECG)
50
Q

Monitors of Nervous System Function: EEG

where are electrodes placed?

A
  • on scalp ( according to international system of placement)
51
Q

Monitors of Nervous System Function: EEG

relates surface head anatomy to underlying brain cortical regions and measures what 3 things?

A

Amplitude

frequency

time

52
Q

Monitors of Nervous System Function: EEG

what are the 4 brain waves monitored

A
  • Alpha
  • Beta
  • Theta
  • Delta

All Blondes Take Dick

53
Q

Monitors of Nervous System Function: EEG

what does the wave forms represent

Alpha:

Beta:

Theta:

Delta:

A

A***_lpha: _***Awake/resting

Beta: Busy thinking

Theta: GETA (general anesthesia)

Delta: Deep Sleep (GETA)

54
Q

Monitors of Nervous System Function: Evoked Potentials

what are the 2 responses seen with EPs

A
  • Latency
  • Amplitude
55
Q

Monitors of Nervous System Function: Evoked Potentials

what is latency?

A
  • time from stimuli to response
    <========>
56
Q

Monitors of Nervous System Function: Evoked Potentials

what is amplitude

A
  • Intensity of response
57
Q

Monitors of Nervous System Function: Evoked Potentials

what do VAA’s do to EP’s

A

Increase latency and decrease amplitude

* this makes a lot of sense now that you understand what the terms mean.. Think about it VAA are going to supress your response to stimuli.. thus increase latency (or the time from stimuli to response) and it will decrease amplitude (or intensity of response). it VAA’s didn’t do this everytime the pt is touched they would immediatly sit up and smack you in the face. and since your not suppressed by VAA’s you have normal latency and amplitude so you will turn your head instantly and scream in pain!!!*

58
Q

Skipped pain pathways!!! if she says it’s important i’ll go back and add it!!

A

But it appears usless to me

59
Q

Somatosensory Evoked Potentials (SSEPs):

A low voltage current applied to what peripheral nerves?

A
  • median
  • post tibia

(usually both)

60
Q

Somatosensory Evoked Potentials (SSEPs):

the low voltage current applied to teh peroheral nerves (median or post tibial), result in an evoked potential (NERVE IMPULSE) that follows the sensory pathway to the brain where the EEG records it’s delivery. it measures the intactness of what pathways???

***and she said to remember this*****

A
  • Dorsal Column Pathways

Remember this

61
Q

Somatosensory Evoked Potentials (SSEPs):

is useful during what surgeries?

A
  • back
  • Spinal cord
  • Cerebral aneurysms
  • AV malformations
  • Deliberate Hypotension
62
Q

Somatosensory Evoked Potentials (SSEPs):

is it important to have a baseline?

63
Q

Somatosensory Evoked Potentials (SSEPs):

you want to maintain a pre-described limit of VAA and do what w/ any changes to anesthestic including IV agents for proper interperation

A

Communicate

64
Q

Somatosensory Evoked Potentials (SSEPs):

Irreversiable SSEP loss closely predicts ____deficits

65
Q

Somatosensory Evoked Potentials (SSEPs):

___% latency and up to __% amplitude decrease is usually acceptable

66
Q

Somatosensory Evoked Potentials (SSEPs):

does this do motor also or just sensory?

67
Q

Brainstem Auditory Evoked Potential (BAEPs or BAERs):

_______ signals are transmited to patient and follow the auditory pathways

68
Q

Visual Evoked Potential:

______ stimuli from flashing diodes in goggles and measures the intactness of visual-optic and geniculocarine tracts

69
Q

Motor Evoked Potential:

measures motor pathways via the ____ or ______ tracts by cortical stimulation and measures motor responses

A
  • Pyramidal
  • Corticospinal
70
Q

Motor Evoked Potential:

is the most technically (easy/difficult) to measure

71
Q

Motor Evoked Potential:

this monitoring may replace what intra-op test?

A

Intra-op wake up test

72
Q

Motor Evoked Potential:

they are most usefull in conjunction with what other monitoring

73
Q

Motor Evoked Potential:

How much NMB can you use during this monitoring

A

None fuck face….. what wrong with you…you trying to fuck the whole thing up? Your new name is Afro Mike!! Congrats num nuts

74
Q

Thats itfor this section I am sure you did great. You are very smart (unless you got that last one wrong) flip to see your prize

Principles 4 (20 decks)

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