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Principles IV > 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
Non-invasive CBF monitoring: transcranial doppler US what the fuck is this is Josh terms?
* 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
26
Non-invasive CBF monitoring: what is the most frequently used method?
Cerebral Oximetry
27
Non-invasive CBF monitoring: Cerebral Oximetry Measures O2 sat of tissues under 2 sensors placed where?
On both sides of forehead
28
Non-invasive CBF monitoring: Cerebral Oximetry measures local _____ \_\_\_\_\_ saturation?
Venous oxygen
29
Non-invasive CBF monitoring: Cerebral Oximetry it measures local venous o2 saturation b/c \_/\_ to \_/\_ of cerebral blood volume is venous
2/3 to 4/5
30
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?
increased O2 extraction
31
Non-invasive CBF monitoring: Cerebral Oximetry Sensore should be placed when? and why?
* preop * to establish a baseline correlated with neuro exam
32
Non-invasive CBF monitoring: Cerebral Oximetry a decrease of \>\_\_\_% indicated inadequate cerebral perfusion
\>20%
33
What are 2 Invasive tech for monitoring CBF?
1. Thermal diffusion CBF monitoring 2. Tissue partial pressure of O2 monitoring
34
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)
No question way to retarded to ask
35
Invasive techniques for CBF monitoring: Thermal Diffusion a probe with a thin catheter containing __ thermistors (5cm apart) are placed in the subcortical white matter
2
36
Invasive techniques for CBF monitoring: Thermal Diffusion what does the proximal thermistor do?
Measures brain temp
37
## Footnote Invasive techniques for CBF monitoring: Thermal Diffusion what does the distal thermistor do?
heated 2 C higher than brain temp
38
Invasive techniques for CBF monitoring: Thermal Diffusion the power to sustain the temp is directly proportional to what?
Blood flow
39
## Footnote Invasive techniques for CBF monitoring: Thermal Diffusion what the fuck is it in josh terms
* 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
Invasive techniques for CBF monitoring: Tissue Partial Pressure gives a good correlation b/t tissue O2 levels and \_\_\_\_
CBF
41
Invasive techniques for CBF monitoring: Tissue Partial Pressure how does it work?
* Diffusion of O2 molecules through an O2 permeable membrane into an electrolyte solution, produces a electrical current proportional to O2
42
Invasive techniques for CBF monitoring: Tissue Partial Pressure this probe is placed in subcortical white matter and stable over ____ periods of time
Long
43
Invasive techniques for CBF monitoring: Tissue Partial Pressure what the fuck is it??? Please josh tell me!!!
* Stick a probe in brain (white mater) measure the O2 crossing it * Produces an electricity!! * Can stay in place for a while
44
Monitors of Nervous System Function: what are the 4 main monitors?
1. Sensory evoked potential (EPs) 2. Electroencephalogram 3. Motor evoked potentials 4. BIS
45
Monitors of Nervous System Function: do you need to place the BIS prior to induction?
Nope!! You don't need a baseline
46
Monitors of Nervous System Function: Bis score 70-80
* Moderate sedation
47
## Footnote Monitors of Nervous System Function: BIS score 40-60
* General anesthesia
48
Monitors of Nervous System Function: BIS score below 60
* Amnesia/ no recall (i thought it was 70 but in class she said 60)
49
Monitors of Nervous System Function: which monitoring system identifies consciousness, unconsciousness, sz activity, stages of sleep, and coma
* Electroencephalogram (ECG)
50
Monitors of Nervous System Function: EEG where are electrodes placed?
* on scalp ( according to international system of placement)
51
Monitors of Nervous System Function: EEG relates surface head anatomy to underlying brain cortical regions and measures what 3 things?
Amplitude frequency time
52
Monitors of Nervous System Function: EEG what are the 4 brain waves monitored
* Alpha * Beta * Theta * Delta All Blondes Take Dick
53
Monitors of Nervous System Function: EEG what does the wave forms represent Alpha: Beta: Theta: Delta:
***_A***_lpha: _***A_***wake/resting ***_B_***eta: ***_B_***usy thinking ***_T_***heta: ***_GETA_*** (general anesthesia) ***_D_***elta: ***_D_***eep Sleep (GETA)
54
Monitors of Nervous System Function: Evoked Potentials what are the 2 responses seen with EPs
* Latency * Amplitude
55
Monitors of Nervous System Function: Evoked Potentials what is latency?
* time from stimuli to response \<========\>
56
Monitors of Nervous System Function: Evoked Potentials what is amplitude
* Intensity of response
57
## Footnote Monitors of Nervous System Function: Evoked Potentials what do VAA's do to EP's
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
Skipped pain pathways!!! if she says it's important i'll go back and add it!!
But it appears usless to me
59
Somatosensory Evoked Potentials (SSEPs): A low voltage current applied to what peripheral nerves?
* median * post tibia (usually both)
60
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\*\*\*\*\*
* Dorsal Column Pathways Remember this
61
Somatosensory Evoked Potentials (SSEPs): is useful during what surgeries?
* back * Spinal cord * Cerebral aneurysms * AV malformations * Deliberate Hypotension
62
Somatosensory Evoked Potentials (SSEPs): is it important to have a baseline?
yes
63
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
Communicate
64
Somatosensory Evoked Potentials (SSEPs): Irreversiable SSEP loss closely predicts \_\_\_\_deficits
Motor
65
Somatosensory Evoked Potentials (SSEPs): \_\_\_% latency and up to \_\_% amplitude decrease is usually acceptable
20% 50%
66
Somatosensory Evoked Potentials (SSEPs): does this do motor also or just sensory?
does both
67
Brainstem Auditory Evoked Potential (BAEPs or BAERs): \_\_\_\_\_\_\_ signals are transmited to patient and follow the auditory pathways
Auditory
68
Visual Evoked Potential: \_\_\_\_\_\_ stimuli from flashing diodes in goggles and measures the intactness of visual-optic and geniculocarine tracts
Visual
69
Motor Evoked Potential: measures motor pathways via the ____ or ______ tracts by cortical stimulation and measures motor responses
* Pyramidal * Corticospinal
70
Motor Evoked Potential: is the most technically _(easy/difficult)_ to measure
Difficult
71
Motor Evoked Potential: this monitoring may replace what intra-op test?
Intra-op wake up test
72
Motor Evoked Potential: they are most usefull in conjunction with what other monitoring
SSEPs
73
Motor Evoked Potential: How much NMB can you use during this monitoring
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
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 IV (18 decks)

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