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Clinical Simulation > Neurologic/Neurosurgical Conditions > Flashcards

Neurologic/Neurosurgical Conditions Flashcards

Myasthenia Gravis, Gullian Barre, Drug Overdose, Stroke, Polio/ALS/Muscular Dystrophy

1
Q

For patients with any neurologic/neuromuscular disease, watch for ventilatory failure by monitoring:

A
  • Tidal volume 5 mL/kg
  • Vital capacity less than 1000mL / >10 ml/kg
  • MIP -20 or more negative
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2
Q

Myasthenia Gravis moves from

A

Descending paralysis

-Mind to Ground

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3
Q

Primary assessment of Myasthenia Gravis

A
  • 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
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4
Q

Secondary assessment of Myasthenia Gravis

A
  • Special tests
  • Spontaneous ventilatory parameters
  • ABG
  • Pulmonary function
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5
Q

Special tests for Myasthenia Gravis

A
  • Edrophonium: Tensilon challenge
  • Electomyography
  • Blood test for Ach Receptor Antibodies
  • Ice pack test
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6
Q

Spontaneous ventilatory parameters - Myasthenia Gravis

A

Decreasing VT, VC, MIP

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7
Q

ABG for Myasthenia Gravis

A
  • Acute ventilatory failure with hypoxemia

- Watch for ventilatory failure PaCO2 >45 torr

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8
Q

What test to diagnose and monitor therapy for Myasthenia Gravis

A

Edrophonium: Tensilon challenge

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9
Q

If VT, VC, MIP and weakness IMPROVE with Tensilon

A

-Myasthenic Crisis: need to give more of this drug

Maintenance drug therapy:

  • Prostigmine (Neostigming)
  • Pyridostigmine (Mestinon, Regonol)*

Amount dictated by Tensilon

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10
Q

If VT, VC, MIP and weakness WORSENS with Tensilon

A

-Cholinergic Crisis: gave too much of this drug

  • Administer ATROPINE to reverse Tensilon
  • -will relieve symptoms of cholinergic crisis
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11
Q

Treatment and management of Myasthenia Gravis

A
  • Closely monitor VT, VC, MIP
  • Bedrest restriction
  • Soft diet to reduce symptoms
  • Oxygen therapy for hypoxemia
  • Hyperinflation therapy
  • Pulmonary hygiene
  • Corticosteriods in severe cases
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12
Q

Myasthenia Gravis

A
  • 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
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13
Q

Guillain-Barre Syndrome

A
  • 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
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14
Q

Gullian Barre moves from

A

Ascending paralysis

-Ground to Brain

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15
Q

Primary assessment of Guillain-Barre Syndrome

A
  • 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
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16
Q

Secondary assessment of Guillain-Barre Syndrome

A
  • Spontaneous ventilatory parameters (decreased VT, VC, MIP)
  • ABG
  • Pulmonary function: reduced volumes (FVC, VT)
  • Special tests
17
Q

ABG of Guillain-Barre Syndrome

A
  • Acute ventilatory failure with hypoxemia

- Watch for ventilatory failure PaCO2 > 45 torr

18
Q

Special tests for Guillain-Barre Syndrome

A
  • Lumbar puncture: high protein level in CSF > 500 mg/dL
  • Abnormal electromyograph
  • Elevated IgM levels
19
Q

Treatment and management of Guillain-Barre Syndrome

A
  • 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
20
Q

Etiology of Drug overdose

A
  • History is often the most significant finding

- Mental illness: depression, addiction

21
Q

Primary assessment in Drug overdose

A
  • Past medical history (most significant finding)
  • Respiratory pattern: slow, shallow
  • Physical appearance: altered LOC
  • Breath sounds: diminished throughout
22
Q

Secondary assessment in Drug overdose

A
  • Drug toxicology

- Monitor results of basic laboratory testing

23
Q

Treatment and management of Drug overdose

A
  • 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
24
Q

Stroke/CVA/Transient Ischemic Attack (TIA)

A

Area of the brain loses blood supply as a result of a vascular occlusion

25
Q

Etiology of Stroke/CVA/Transient Ischemic Attack (TIA)

A
  • Cerebral thrombi or emboli (Most common)
  • Atherosclerosis
  • Hypertension
26
Q

Primary assessment of Stroke/CVA/Transient Ischemic Attack (TIA)

A
  • Past medical history
  • Respiratory pattern: *Cheyne-Stokes
  • Physical appearance: motor + speech loss
27
Q

Secondary assessment of Stroke/CVA/Transient Ischemic Attack (TIA)

A
  • Special tests: CT/MRI of the brain, cerebral angiogram

- ICP monitoring: may be elevated / normal 5-10 mmHg

28
Q

Treatment and management of Stroke/CVA/Transient Ischemic Attack (TIA)

A
  • Treatment should be initiated with 6 hours of symptoms of onset
  • Drug therapy
  • Mechanical ventilation for ventilatory failure or reduce ICP
29
Q

Drug therapy for Stroke/CVA/Transient Ischemic Attack (TIA)

A
  • Anticoagulation therapy
  • Vasodilators
  • Thrombolytic therapy for acute ischemic stroke
30
Q

Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy

A

Neuromuscular disorders that involve loft of voluntary muscle action

31
Q

Etiology - Poliomyelitis

A

Viral infection (Polio)

32
Q

Etiology - Muscular Dystrophy

A

Genetic disorder

33
Q

Etiology - Tetanus/Botulism

A

Puncture Wound

34
Q

Primary assessment of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy

A
  • Past medical history: previous admission for disease

- current medications: drug therapy for specific disease

35
Q

Secondary assessment of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy

A
  • ABG: watch for ventilatory failure

- Spontaneous ventilatory parameters: decreasing VT, VC, MIP

36
Q

Treatment and management of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy

A
  • 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

Clinical Simulation (7 decks)

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