Neurological Assessment Flashcards

Question

Doll's Eyes Reflex

Answer 1

Typically the doll's eyes reflex is elicited by turning the head of the unconscious patient while observing the eyes. The eyes will normally move as if the patient is fixating on a stationary object. If there is a negative doll's eyes reflex then the eyes remain stationary with respect to the head.

Answer 2

Testing by passing a bright light in front of both open eyes and watching for movement PERRLA (Pupils Equal, Round, Reactive to Light, Accommodation) Describe size, congruency, response to light, and accommodation Will assess cranial nerves II and III

Answer 3

One pupil is larger than the other

Answer 4

Pontine Hemorrhage Narcotics

Answer 5

Dilated Pupils Brain injury Anticholinergics

Answer 6

Severe cerebral damage

Answer 7

Ominous sign, but there are other reasons beside brain death

Answer 8

Anxiety Pain Patient-vent dysynchrony Agitation self-removal of tubes/catheters Myocardial ischemia Assault of the care-provider Family dissatisfaction

Answer 9

* Prolonged mech. ventilation and length of ICU stay * Tracheostomy * Inability to communicate * DVT * Added cost * VAP Additional testing * Cannot evaluate for delirium

Answer 10

Patient has any movement in response to voice but no eye contact

Answer 11

Patient has any movement to physical stimulation

Answer 12

Patient has no response to any stimulation

Answer 13

**1. Observe the Patient-**The patient is alert, restless, or agitated (Score 0 to +4) ## Footnote **2.If Not Alert, State Patient Name and Ask to Open Eyes and Look at Speaker** **3.There is No Response to Verbal Stimulation then Physically Stimulate Pt. by Shaking Shoulder and/or Rubbing Sternum**

Answer 14

Delirium is a sign of acute brain dysfunction and is a disturbance of consciousness with a reduced ability to sustain or shift attention Will develop over a short period of time and tends to fluctuate over the course of the day The presence of delirium indicates an underlying medical issue such as sepsis, CHF, substance intoxication, or a side effect of other medications Over sedation will prevent the assessment of delirium-This means we are unable to treat the condition that it causing it

Answer 15

ICU Psychosis ICU Syndrome Acute Confusional State

Answer 16

Hyperactive (ICU Psychosis) Hypoactive Mixed

Answer 17

The Confusion Assessment for ICU (CAM-ICU) The Intensive Care Delirium Screening Checklist (**ICDSC**)-Used in Calgary Both assessment are similar Monitoring will help to optimize the delivery of sedatives and analgesics, and other psychoactive drugs, and look for other underlying medical causes to ultimately to improve patient outcomes

Answer 18

D-Drugs E-Enviromental Factors L-Labs I-Infection R-Respiratory Status I-Immobility O-Organ Failure U-Unrecongnized Dementia S-Shock

Answer 19

T-Toxic situations, H-Hypoxemia I-Infection N-Nonpharmacological K-K+ or elctroylte problems

Answer 20

The most important step in delirium management is **early assessmen**t

Answer 21

Identify etiology Identify risk factors Implement non-pharmacologic management (when RASS is -3) Consider pharmacologic treatment- Assess current sedation level, SATs and which meds are being used. Consider anti-psychotic meds How important is it? -“Patients whose daily sedation was interrupted had significantly fewer symptoms of PTSD after critical illness.”

Answer 22

* Used when RASS is ≥ 3 * Frequent reorientation of patient * Trying to keep the patient alert and oriented * Convey day, date, place, and reason for hospitalization * Update the whiteboards with caregiver names * Request placement of a clock and calendar in room * Discuss current events * Cognitively stimulating activities * Sleep protocol (day/night routines) * Normal day-night variation in illumination * Use “time out” strategy to minimize interruptions in sleep * Maintain ventilator synchrony * Promote comfort and relaxation (e.g., back care, oral care, washing face/hands, and daytime bath, massage) * Early mobility and ROM exercises * All patient should be eligible for early exercise and mobility * Timely removal of catheters, restraints… * Use of eye-glasses, hearing aids etc * Will help them to be more alert in their surroundings * Early correction of dehydration * Minimize unnecessary noises * Noise reduction strategies (e.g. minimize noise outside the room, offer white noise or earplugs) * Monitor patient’s pain level Use an objective scale FACES, BPS, VAS, CPOT, etc

Answer 23

Designed to standardize care processes and improve collaboration among the healthcare team Its use will help break the cycle of over sedation and prolonged ventilation ABC=Awakening and Breathing Coordination D=Delirium Non pharm Interventions E=Early Exercise and Mobility

Answer 24

SAT is period of time when the sedative medications are discontinued and the patient is allowed to wake up and achieve a normal level of alertness Will prevent the accumulation of sedative drugs by giving them a chance to metabolize (decreases the risk of delirium) Provides an opportunity for more effective weaning from the ventilator

Answer 25

Often for better results when we are doing a awakening trial we will also get the patient to try and breath on their own too rather than do the trials separately When combined they may be referred to as a wake up a breath trial The combination of these two is superior to conventional sedation and spontaneous breathing trails To perform safely must make sure there are no contra indications in the patient

Answer 26

Normal ICP is **10-15 mmHg** Small fluctuations normal; variability \> 10 mmHg a bad sign At **15-20 mmHg** capillary bed is compressed and microcirculation is compromised **\>20 mmHg** is considered intracranial hypertension. At **30-35 mmHg** venous drainage is impeded and edema develops in uninjured tissue

Answer 27

Monitor patients at risk for life-threatening intracranial hypertension Monitor evidence of infection Assess effects of therapies for reducing ICP

Answer 28

CPP=MAP-ICP ## Footnote Cerebral perfusion cannot be maintained if ICP increases to within 40-50 mmHg of the MAP. When ICP ≅ MAP perfusion stops and brain dies.

Answer 29

1. **Fluid Filled Systems-**Use an external pressure like in hemodynamics (Interventricular catheter and subarachnoid bold) 2. **Solid State System**-Miniature pressure transducer inserted into the lateral ventricle, brain parenchyma, suprachnoid, or epidural space

Answer 30

Approximates the **global cerebral oxygenation** Jugular venous oxygen saturation (SjvO2) reflects the **balance between cerebral oxygen delivery and the cerebral metabolic rate of oxygen (CMRO2)** Used as a form of monitoring in a patient with TBI A catheter is inserted into the internal jugular vein and directed upwards so that the tip rests in the jugular venous bulb which is located at the base of the brain Blood samples can be drawn from here and analyzed for JvO2 (partial pressure of O2 in jugular vein) or SjVO2 (saturation level) **A normal SjVO2 is 50-75%** Can be measured continuously with a specialized catheter

Answer 31

Decreased cerebral blood flow Cerebral hypoperfusion Possible ischemia (Can help with early diagnosis of ischemia) Increased cerebral metabolic rate (febrile, seizures) Arterial hypoxemia

Answer 32

Reduced cerebral metabolic rate Hypothermia sedatives brain death

Answer 33

CBF can be decreased by head injury, thromboembolism, intracranial hypertension, hypotension, hyperventilation, or vasospasm. If CMRO2 remains constant or increases under these conditions, SjVO2 will decrease. Arterial hypoxia and increased CMRO2 (e.g., febrile illness, seizures) can also result in SjVO2 desaturation. Correct interpretation of increased SjVO2 requires confirmation that the catheter tip is at the jugular bulb. Reduced CMRO2 (e.g., hypothermia, sedatives), increased CBF, pathologic arterial-venous communications, and brain death may result in increased SjVO2

Answer 34

A new technology that is non-invasive and determines saturation of the underlying tissue Because it is non-invasive it may have an increased value as a monitor/diagnostic uses Can be used to determine cerebral oxygenation or other locations Used often in the OR and has investigative uses in the NICU Can be trended or used for “spot checks” Just like with the SjvO2, the changes in saturation levels can indicate underlying conditions

Answer 35

Even with normal ICP and CPP readings, cerebral hypoxia can still develop Early detection of cerebral hypoxia and impending ischemia are key to preventing secondary brain injury. The Licox system is a monitor connected to a catheter that is inserted in the brain tissue, and measures brain tissue oxygenation (PbtO2) Done in patients who have a traumatic or neurologic brain injury

Answer 36

of Twitches Approximate % blockade 0/4 100% 1/4 90% 2/4 85% 3/4 80% 4/4 75% or less

Answer 37

Monitor the effects of neuromuscular blockade agents (paralytics) Electrodes placed over ulnar nerve at wrist or elbow typically (though other sites can be used) Response to stimulus is monitored by the muscle twitches and permits titration to desired effect Use can result in less medication use and allow quicker recovery Reduction of the NMBA infusion rate is indicated in order to prevent prolonged paralysis and severe weakness during ICU recovery.

Answer 38

A recording of the brains electrical activity via the scalp Used to diagnose and monitor: Epilepsy and other seizure activity, Coma Encephalopathies, Brain death

Answer 39

Increasing minute volume with the goal of decreasing the PaCO2 (They technically are not hyperventilating) Know the PaCO2 (35-40) and PaO2 (80-120) TBI goals Although hyperventilation decreases ICP, cerebral perfusion pressure (CPP) is the most critical element to monitor!

Answer 40

Only done acutely /short-term

Answer 41

The low PaCO2 results in vasoconstriction of the cerebral arteries, reducing blood in the … and thus reducing the intracranial pressure

Answer 42

The decreased blood flow to the brain results in decreased oxygen delivery and anoxic brain injury

Answer 43

General anesthesia Cleaning of site Incision via frontal or parietal region Burr hole drilled till through the skull Underlying dura is incised Catheter inserted into ventricle (lateral) Incision closed; monitored

Answer 44

To allow for monitoring of ICP To reduce ICP For example, physician orders state “open EVD when ICP \>25 mmHg” When EVD is opened ICP cannot be monitored Relieve hydrocephalus (fluid/blood in the intracranial cavity)

Answer 45

Hemorrhage Infection Malfunction of equipment (blockage; displacement)

Answer 46

Lowering of the patient’s body temperature to help reduce the risk of ischemic injury after a period of insufficient blood flow Most deaths caused by therapeutic hypothermia occurred during the rewarming phase of the procedure, deaths that could have been easily avoided by slow and precise rewarming. Goal temperature 32-34° C.

Answer 47

Post-cardiac arrest Stroke Traumatic brain or spinal cord injury

Answer 48

The benefits was though to be caused through the decrease in cellular metabolism, but now it is thought that there is more to it than that and possible mechanisms include Interrupt cell apoptosis Stabilizes cell membrane, making it more impermeable and therefore withstand unwanted ion shifting Also helps reduce reperfusion injury (damage caused by oxidative stress)

Answer 49

Arrhythmias Clotting problems Increased risk of infection Increased risk of electrolyte imbalance.

Answer 50

Cooling catheters (femoral vein, cooled saline; highly accurate control of temp)-Fastest, most precise and efficient Transnasal evaporative cooling (two cannula inserted in nasal cavity; sprays a cool mist)

Answer 51

Water blankets, torso vest, leg wraps Cool caps Cool collars

Answer 52

Oversedation Failure to initiate SBTs; longer duration of mechanical ventilation Longer duration of ICU stay Impede assessment of neurological function Increases risk for delirium Numerous agent-specific adverse events

Answer 53

Any drug that reduces CNS arousal Sleep is not the same as sedative Includes: Benzodiazepines, Nonbenzodiazepines, Barbituates

Answer 54

any drug that induces sleep

Answer 55

any drug that reduces symptoms of anxiety

Answer 56

Any drug that reduces the sensation of pain General anesthesia has four characteristics: unconsciousness, analgesia, muscle relaxation, and depression of reflexes.

Answer 57

Any drug that reduces the ability to perceive sensations

Answer 58

Many drugs can have multiple effects! Effect(s) often dose dependent Can get sedation effects at low dose and full anesthetic at high dose. Most available evidence regarding sedatives and analgesics in ICU patients indicates that it may be **less important which drugs are delivered than their proper titration using goal-directed delivery** (RASS Target) to optimize patient comfort while avoiding complications such as prolonged mechanical ventilation or reintubation

Answer 59

Used for its effects of sedative (madadala), hypnotic (valum), anxiolytic Used to treat: anxiety, agitation, insomnia, seizures/ status epilepticus, muscle spasms, alcohol withdrawal (DTs) Can be short, intermediate or long-acting (longer-acting used for anxiety)

Answer 60

Can cause loss of airway reflexes at high doses and decreased tidal volume at lower doses

Answer 61

flumazenil (Romazicon)

Answer 62

Flurazepam Triazolam (Halcion) Zopiclone (Imovane)

Answer 63

**Category:** Benzodiazepines **Generic Name:** Midazolam **Trade Name:** Versed **Reversal Agent:** Flumazenil (Romazicon) **Cation:** High dose loss of air reflexes, low doses decreased tidal volume **Used For:** Anxiety/ Hypnotic

Answer 64

**Category:** Benzodiazepines **Generic Name:** Lorazepam **Trade Name:** Ativan **Reversal Agent:** Flumazenil (Romazicon) **Cation:** High dose loss of air reflexes, low doses decreased tidal volume **Used For:** Anxiety/ Hypnotic

Answer 65

**Category:** Benzodiazepines **Generic Name:** Diazepam **Trade Name:** Valium **Reversal Agent:** Flumazenil (Romazicon) **Cation:** High dose loss of air reflexes, low doses decreased tidal volume **Used For:** Anxiety/ Hypnotic

Answer 66

**Category:** Benzodiazepines **Generic Name:** Zopiclone **Trade Name:** Imovane **Reversal Agent:** Flumazenil (Romazicon) **Cation:** High dose loss of air reflexes, low doses decreased tidal volume **Used For:** Sleep

Answer 67

**Category:** Benzodiazepines **Generic Name:** Triazolam **Trade Name:** Halcion **Reversal Agent:** Flumazenil (Romazicon) **Cation:** High dose loss of air reflexes, low doses decreased tidal volume **Used For:** Sleep

Answer 68

**Category:** Benzodiazepines **Generic Name:** Flurazepam **Trade Name:** Dalmane **Reversal Agent:** Flumazenil (Romazicon) **Cation:** High dose loss of air reflexes, low doses decreased tidal volume **Used For:** Sleep

Answer 69

**Category:** Benzodiazepines **Generic Name:** Alprazolam **Trade Name:** Xanax **Reversal Agent:** Flumazenil (Romazicon) **Cation:** High dose loss of air reflexes, low doses decreased tidal volume **Used For:** Anxiety/ Hypnotic

Answer 70

**Generic Name:** Dexmedetomidine **Trade Name:** Precedex **Effects:** Sedative, analgesic, sympatholytic, and anxiolytic effects that blunt many of the cardiovascular responses in the perioperative period Commonly used in ICU and OR *_Can provides sedation without respiratory system depression_* It has many benefits (less delirium, shortened time to extubation, reduced ICU stay…) but is very expensive! Per pill it is way more expensive, but it will reduce cost of a prolonged ICU stay Considerd to be superior or lorazepam and midazolam It reduces the requirements for volatile anesthetics, sedatives and analgesics without causing significant respiratory depression

Answer 71

E.g. Thiopental (Sodium Pentothal), phenobarbital (Luminal) One of the oldest group of sedative drugs; use has largely been replaced by benzo’s Can be used as anesthetics (thiopental) or hypnotics

Answer 72

**Category:** Barbituates **Generic Name:** Phenobarbital **Trade Name:** Luminal **Reversal Agent:** None **Used For:** Anticonvulsant for seizures

Answer 73

**Category:** Barbituates **Generic Name:** Sodium Pentothal **Trade Name:** Thiopental **Reversal Agent:** None **Used For:** Anesthesia

Answer 74

Stage 1:Aanalgesia; patient retains consciousness without experiencing pain (“conscious sedation”) Stage 2: Loss of consciousness Stage 3: respiratory depression; loss of reflexes (“surgical anesthesia”) Stage 4: complete loss of respiratory drive; may be loss of cardiovascular tone] All of the drugs discussed, in a dose-dependent fashion, can result in the different stages of anesthesia! (i.e. not just anesthetic drugs!)

Answer 75

**Category:** Anesthetic **Generic Name:** Propofol **Trade Name:** Diprivan **Reversal Agent:** None **Used For:** Sedation (especially in mechanically ventilated pt.) for both induction, maintenance of anesthesia, as well as conscious sedation **Notes:** Short-acting hypnotic agent.Recovery is rapid and “clear”. Does NOT have analgesic properties

Answer 76

Hypotension Respiratory depression Pain on injection

Answer 77

Induction and maintenance of general anesthesia Sedation for mechanically ventilated patients Procedural sedation

Answer 78

Opioid – derivative of naturally occurring drug mixture opium, derived from the Poppy

Answer 79

Pinpoint pupils, coma, and respiratory depression

Answer 80

Reversal agents are the narcotic antagonists Naloxone (Narcan) or naltrexone (ReVia). Note: the reversal agent doesn’t last as long as the drug itself! Redosing may be needed!

Answer 81

Can be given via a bolus or infusion;

Answer 82

**Category:** Narcotic **Generic Name:** Morphine **Trade Name:** N/A **Reversal Agent:** Naloxone (Narcan) or Naltrexone (ReVia). **Used For:** Can be aerosolized for palliative care

Answer 83

**Category**: Narcotic **Generic Name:** Fentanyl **Trade Name:** Sublimaze **Reversal Agent:** Naloxone (Narcan) or Naltrexone (ReVia). **Used For:** Analgesics, Sedation, Decreased preload and afterload on left ventricle, and antitussive (cough supression)

Answer 84

**Category:** Narcotic **Generic Name:** Oxycodone **Trade Name:** N/A **Reversal Agent:** Naloxone (Narcan) or Naltrexone (ReVia). **Used For:** Analgesics, Sedation, Decreased preload and afterload on left ventricle, and antitussive (cough supression)

Answer 85

**Category:** Narcotic **Generic Name:** Codeine **Trade Name:** N/A **Reversal Agent:** Naloxone (Narcan) or Naltrexone (ReVia). **Used For:** Analgesics, Sedation, Decreased preload and afterload on left ventricle, and antitussive (cough supression)

Answer 86

**Category:** Narcotic **Generic Name:** Meperidine **Trade Name:** Demerol **Reversal Agent:** Naloxone (Narcan) or Naltrexone (ReVia). **Used For:** Analgesics, Sedation, Decreased preload and afterload on left ventricle, and antitussive (cough supression)

Answer 87

Analgesia Sedation Decreases preload and afterload on the left ventricle Antitussive qualities (cough supression)

Answer 88

Nausea and vomiting Constipation Tolerance/addiction Causes release of histamine-Thus narcotic use in someone with hypersentive airways is discouraged! Bronchospasm, rashes, inflammation can result

Answer 89

Acetaminophen (e.g. Tylenol/acetaminophen) Salicylates (Aspirin/acetylsalicylic acid) Ibuprofen (e.g. Advil/ibuprofen)

Answer 90

**Category:** Non Steroid Anti Inflammatory **Generic Name:** Acetaminophen **Trade Name:** Tylenol **Reversal Agent:** Mucomyst (Acetylcysteine) **Used For:** In ICU used for it’s anti-pyretic effects and not for pain control **Notes:** Overdose of acetaminophen can cause hepatotoxicity

Answer 91

**Category:** Non Steroid Anti Inflammatory **Generic Name:** Asiprin/ Acetylsaicylic Acid **Trade Name:** Aspirin **Reversal Agent:** None **Used For:** Given in acute coronary syndromes as it inhibits platelet aggregation **Notes:** Asthmatics can be sensitive to aspirin resulting in bronchospasm!

Answer 92

**Category:** Non Steroid Anti Inflammatory **Generic Name:** Ibuprofen **Trade Name:** Advil **Reversal Agent:** None **Used For:** Has analgesic, anti-inflammatory and antipyretic effects **Notes:** Not typically used in ICU environment

Answer 93

**Category:** Anti-Psychotics **Generic Name:** Haloperidol **Trade Name:** Haldol **Reversal Agent:** None **Used For:** Control active psychotic symptons, delirium management

Answer 94

= Paralytics or skeletal muscle relaxants All patients require proper eye care as no more blinking; light taping of eyes Paralyze only!! (i.e. lack amnesic, sedative and analgesic properties!) MUST sedate patient and use analgesics as necessary! Two types: 1) Non-depolarizing 2) Depolarizing

Answer 95

Slow onset of action with a longer duration Mechanism of action: Competitively blocking the binding of acetylcholine to its receptors preventing Acetylcholine from depolarizing the muscle fiber causing vagolytic effedct The increased MAP can incresae ICP! These tend to be used to maintain paralysis in ICU

Answer 96

Cardiovascular effects (tachycardia, vasoconstriction and hypertension). Pavulon the worst. Have a tendency to release histamine Need to provide ventilation!

Answer 97

Neostigmine-Neostigmine is a cholinesterase inhibitor (cholinesterase is the enzyme that breaks down AcH)

Answer 98

**Category:** Non Depolarizing Neuromuscular Blocking Agent **Generic Name:** Rocuronium **Trade Name:** Zemuron **Reversal Agent:** Neostigmine (prostigmin) **Used For:** Maintain Paralysis in ICU

Answer 99

**Category:** Non Depolarizing Neuromuscular Blocking Agent **Generic Name:** Pancuronium **Trade Name:** Pavulon **Reversal Agent:** Neostigmine (prostigmin) **Used For:** Maintain Paralysis in ICU

Answer 100

**Category:** Non Depolarizing Neuromuscular Blocking Agent **Generic Name:** Atracurium **Trade Name:** Trecrium **Reversal Agent:** Neostigmine (prostigmin) **Used For:** Maintain Paralysis in ICU

Answer 101

**Category:** Non Depolarizing Neuromuscular Blocking Agent **Generic Name:** Tubocurarine **Trade Name:** N/A **Reversal Agent:** Neostigmine (prostigmin) **Used For:** Maintain Paralysis in ICU

Answer 102

Rapid onset; short duration Used for short procedures (e.g. intubation) Succinylcholine (Anectine) There are NO reversal agents!! Sensitivity to Succinycholine –metabolized by plasma cholinesterase. Pts with abnormal or deficient pseudocholinesterase do not meatbolize effective and have a prolonged recovery requiring mechanical ventialitn

Answer 103

Act by depolarizing the muscle fiber and prolonging the depolarized state results in fasiculations (uncoordinated skeletal muscle contractions) First depolarize the muscle fiber and then prolong the depolarized state to prevent repolarization

Answer 104

Tachycardia, hypertension Histamine release (and thus brochospasm; hypotension) Hyperkalemia Increased ICP Malignant hyperthermia (rarely) Sensitivity to Succinycholine Muscle pain and soreness

Answer 105

Is a genetic defect of muscle metabolis and potentiall fatal hypermetabolic state. Treated with dantrolene

Answer 106

For intubation Reduce ICP in intubated patients with uncontrollable ICP To achieve patient-ventilator synchrony To reduce oxygen consumption To stop status epilepticus or shivering (therapeutic hypothermia) In surgery, or to facilitate procedures or diagnostic studies To paralyze selected patients who must remain immobile (e.g. trauma patients).

Answer 107

PacO2=35-40 PaO2-80-120

Answer 108

Anything that stimulates B1 thus: epi, norepi, dopamine (moderate/cardiac dose), Dobutamine, Atropine

Answer 109

Levophed, Phenylephrine and dopamine (high/pressor dose).

Answer 110

Bronchodilation (for receptors in the lungs) and vasodilation (due to the receptors in the periphery)

Answer 111

The increased HR and contractility cause an increase in myocardial demand/oxygen consumption and myocardial irritability. Also decreased time in diastole…may impact filling time at high rates.

Answer 112

Dose Dependent!! While there is overlap it is primarily: Low Dose (1-5 mcg/kg/min) results in renal and splanchnic vasodilation (due to dopaminergic receptor stimulation) Moderate Dose (5-10 mcg/kg/min) results in increased HR, contractility and rate of conduction due to B1 stimulation High Dose (10-20 mcg/kg/min) results in increased SVR and increased BP due to a1 stimulation

Answer 113

In pulsesless states! VT, VFib, PEA and asystole List the alternative drug that may be given instead of epi in these cases.-Vasopressin Describe why this alternative drug may have advantages over epinephrine in this situation.-No B1 stimulation thus doesn’t further stress the heart (beyond the increased afterload it results) with the increased HR and increased irritability

Answer 114

Inhibit phosphodiesterase III (an enzyme that breaks down cAMP). Increased levels of cAMP in the heart results in increased inotropism and increased cAMP in peripheral smooth muscles causes vasodilation

Answer 115

Brain and spinal cord

Answer 116

Made up of 12 pairs of cranial nerves and 31 pairs spinal nerves Most of the cranial nerves originate in the brainstem Spinal nerves from the vertebral column

Answer 117

Patient is awake with sustained eye opening and eye contact

Answer 118

Patient awakened with eye opening and eye contact, but not sustained

Answer 119

Prevent pain and anxiety Decrease oxygen consumption Decrease the stress response Patient-ventilator synchrony With newer vents better to adjust mode/setting for pt-vent synchrony. Avoid adverse neurocognitive sequelae (depression; PTSD) Sequelae--is a pathological condition resulting from a disease, injury or other trauma

Answer 120

Pt. comfort has to be the primary goal Provide for agitation/anxiety free, amnesia, comfort Trying to achieve a balance-TIGHT TITRATION

Answer 121

Midazolam (Versed) Iorzepam (Ativan) Diazepam (Valium) Alprazolam (Xanax)

Answer 122

C. 10-15mmHg

Answer 123

E. B and C

Answer 124

D. Brain Tumor

Answer 125

C. Venous drainage is impeded and edema develops

Answer 126

Reduced cerebral metabolic rate due to hypothermia, sedatives, or brain death.

Answer 127

No reversal for succinylcholine.

Answer 128

Low-normal PaCO2 to vasoconstrict the cerebral arteries and reduce intracranial pressure.

Answer 129

C. Extra ventricular drain

Answer 130

E. All of the above

Answer 131

32-34 degrees celsius.

Answer 132

F. A and B

Answer 133

PaO2\>80-120 mmHg, PaCO2 35-40 mmHg, ICP\<20 mmHg

Answer 134

B. Seizure control

Answer 135

Midazolam (Versed) Lorazepam (Ativan)

Answer 136

Neostigmine

Answer 137

F. A, B, and D

Brainscape's Knowledge GenomeTM

Neurological Assessment Flashcards

Brainscape's Knowledge Genome^TM