Neurologic/Neurosurgical Conditions Flashcards
Myasthenia Gravis, Gullian Barre, Drug Overdose, Stroke, Polio/ALS/Muscular Dystrophy
For patients with any neurologic/neuromuscular disease, watch for ventilatory failure by monitoring:
- Tidal volume 5 mL/kg
- Vital capacity less than 1000mL / >10 ml/kg
- MIP -20 or more negative
Myasthenia Gravis moves from
Descending paralysis
-Mind to Ground
Primary assessment of Myasthenia Gravis
- Past medical history: gradual onset of weakness
- Physical appearance (don’t pick pupillary response): general weakness that improves with rest, drooping eyelids, double vision (diplopia), dysphagia
- Respiratory pattern
- Breath sounds
Secondary assessment of Myasthenia Gravis
- Special tests
- Spontaneous ventilatory parameters
- ABG
- Pulmonary function
Special tests for Myasthenia Gravis
- Edrophonium: Tensilon challenge
- Electomyography
- Blood test for Ach Receptor Antibodies
- Ice pack test
Spontaneous ventilatory parameters - Myasthenia Gravis
Decreasing VT, VC, MIP
ABG for Myasthenia Gravis
- Acute ventilatory failure with hypoxemia
- Watch for ventilatory failure PaCO2 >45 torr
What test to diagnose and monitor therapy for Myasthenia Gravis
Edrophonium: Tensilon challenge
If VT, VC, MIP and weakness IMPROVE with Tensilon
-Myasthenic Crisis: need to give more of this drug
Maintenance drug therapy:
- Prostigmine (Neostigming)
- Pyridostigmine (Mestinon, Regonol)*
Amount dictated by Tensilon
If VT, VC, MIP and weakness WORSENS with Tensilon
-Cholinergic Crisis: gave too much of this drug
- Administer ATROPINE to reverse Tensilon
- -will relieve symptoms of cholinergic crisis
Treatment and management of Myasthenia Gravis
- Closely monitor VT, VC, MIP
- Bedrest restriction
- Soft diet to reduce symptoms
- Oxygen therapy for hypoxemia
- Hyperinflation therapy
- Pulmonary hygiene
- Corticosteriods in severe cases
Myasthenia Gravis
- Chronic disorder of the neuromuscular junction that interferes with chemical transmission of acetylcholine
- Related to circulating antibodies of the autoimmune system
- Descending paralysis: Mind to Ground
Guillain-Barre Syndrome
- Rare disorder of the peripheral nervous system.
- Most likely an immune disorder that causes inflammation and deterioration of the patients peripheral nervous system
- Onset frequently occurs 1-4 wks after a febrile illness caused by mild respiratory or gastrointestinal viral or bacterial infection
Gullian Barre moves from
Ascending paralysis
-Ground to Brain
Primary assessment of Guillain-Barre Syndrome
- Past medical history: febrile illness, often viral in nature, decreased WBC
- Physical appearance: acute weakness especially in legs
- Respiratory pattern: shallow breathing
- Breath sounds: diminished w/ crackles and rhonchi
Secondary assessment of Guillain-Barre Syndrome
- Spontaneous ventilatory parameters (decreased VT, VC, MIP)
- ABG
- Pulmonary function: reduced volumes (FVC, VT)
- Special tests
ABG of Guillain-Barre Syndrome
- Acute ventilatory failure with hypoxemia
- Watch for ventilatory failure PaCO2 > 45 torr
Special tests for Guillain-Barre Syndrome
- Lumbar puncture: high protein level in CSF > 500 mg/dL
- Abnormal electromyograph
- Elevated IgM levels
Treatment and management of Guillain-Barre Syndrome
- Directed at stabilization of vital signs and supportive care
- Initially patients should be managed in the ICU
- Oxygen therapy for hypoxemia
- Hyperinflation therapy (IS,IPPB)
- Pulmonary hygiene
- Plasmapheresis: severe cases only
Other:
- Anti coagulation therapy: watch for pulmonary embolism
- Physical therapy
- Corticosteroids
Etiology of Drug overdose
- History is often the most significant finding
- Mental illness: depression, addiction
Primary assessment in Drug overdose
- Past medical history (most significant finding)
- Respiratory pattern: slow, shallow
- Physical appearance: altered LOC
- Breath sounds: diminished throughout
Secondary assessment in Drug overdose
- Drug toxicology
- Monitor results of basic laboratory testing
Treatment and management of Drug overdose
- Placement of an artificial airway is the first priority
- Mechanical ventilation for ventilatory failure
- Naloxone (Narcan) can be used to reverse a narcotic overdose
- Acetylcysteine: for acetaminophen overdose
Stroke/CVA/Transient Ischemic Attack (TIA)
Area of the brain loses blood supply as a result of a vascular occlusion
Etiology of Stroke/CVA/Transient Ischemic Attack (TIA)
- Cerebral thrombi or emboli (Most common)
- Atherosclerosis
- Hypertension
Primary assessment of Stroke/CVA/Transient Ischemic Attack (TIA)
- Past medical history
- Respiratory pattern: *Cheyne-Stokes
- Physical appearance: motor + speech loss
Secondary assessment of Stroke/CVA/Transient Ischemic Attack (TIA)
- Special tests: CT/MRI of the brain, cerebral angiogram
- ICP monitoring: may be elevated / normal 5-10 mmHg
Treatment and management of Stroke/CVA/Transient Ischemic Attack (TIA)
- Treatment should be initiated with 6 hours of symptoms of onset
- Drug therapy
- Mechanical ventilation for ventilatory failure or reduce ICP
Drug therapy for Stroke/CVA/Transient Ischemic Attack (TIA)
- Anticoagulation therapy
- Vasodilators
- Thrombolytic therapy for acute ischemic stroke
Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy
Neuromuscular disorders that involve loft of voluntary muscle action
Etiology - Poliomyelitis
Viral infection (Polio)
Etiology - Muscular Dystrophy
Genetic disorder
Etiology - Tetanus/Botulism
Puncture Wound
Primary assessment of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy
- Past medical history: previous admission for disease
- current medications: drug therapy for specific disease
Secondary assessment of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy
- ABG: watch for ventilatory failure
- Spontaneous ventilatory parameters: decreasing VT, VC, MIP
Treatment and management of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy
- Closely monitor Vt,VC,MIP
- -intubate and initiate MV
-Drug therapy: Paralyzing agents to relax jaw for intubation and ventilation in case of tetanus/botulism
