Neurological disorders - Pathophysiology and pharmacology

Question 1

primary brain injury can be caused by …

Answer 1

• direct impact, fall, shake- acceleration/deseleration

Question 2

Secondary injury can cause …

Answer 2

• Haemorrhage
• Oedema
• Haematoma
• Dura tearing
• Structural movement
• Obstruction to CSF flow
• Hypoxia
• pH alterations

Question 3

Monro-Kelli doctrine

Answer 3

describes how the brain compensates if a mass takes up space in the cranial cavity.
- less csf

Question 4

Why may a pt involved in an accident be at risk of hypovolaemia

Answer 4

scalp wounds can bleed profusely

Question 5

What is brain herniation

Answer 5

when ICP increases the brain will move to an area of lower pressure by dropping into the area of the brainstem - palliative process

Question 6

mannitol

pharmacodynamics

Answer 6

osmotic diuretic (type of sugar)

Question 7

mannitol

pharmacokinetics

Answer 7

ADME - induces movement of intracellular water to extracellular and vasculaer spaces, excreted by the kidneys

Question 8

mannitol

indications, contra, AE

Answer 8

indications: diuresis, ^ICP, glaucoma

Contra: hypersensitivity, severe heart failure, pulmonary congestion, disturbance to the blood brain barrier, dehydration.

AE: N&V, dizziness, hypotension, ARF, acidosis

Question 9

Tazopip

Pharmacodynamics:

Answer 9

Broad spectrum semisynthetic penicillin antibiotic – contain Piperacillin and Tazobactam. Piperacillin inhibts bacterial cell wall synthesis – Tazobactam inhibits the enzyme beta-lactamase – that would normally prevent Piperacillin from working. Combining the two makes it more effective

Active against Gram-positive and Gram-negative aerobic and anaerobic bacteria

Question 10

Tazopip

Pharmacokinetics

Answer 10

ADME – excreted from kidneys. Caution in acute kidney injury and renal disease

Question 11

Tazopip

indications, contra, AE, interactions

Answer 11

Indications -Used for: LTI’s, UTI’s,intra abdominalinfections, skin infections, gynae infections

Contraindications - Allergic reactions to penicillin/cephalosporins & clauvalinic acid (Augmentin), jaundice

Adverse effects -nausea, vomiting,clotting problems, raised liver enzyme, resistance to therapy in prolonged use, false positives for glucose in urine

Interactions -Other antibiotics,Vecuronium, Methotrexate, Heparin and anticoagulants

Question 12

Causes of neuro deterioration

External factors:

Answer 12

Traumatic brain injury
Alcohol
Drugs / medication / poisoning e.g. envenomation
Environment e.g. hypothermia

Question 13

Causes of neuro deterioration

Internal factors

Answer 13

Stroke

Blood glucose - Hypoglycaemia mimics stroke symptoms

Neuro disorders e.g. Parkinsons disease

Question 14

D - Assessment

Answer 14

Assess conscious level

• Rapid – AVPU
• Accurate - Glasgow Coma Score

Capillary Blood Glucose Measurement

Question 15

GCS elements

Answer 15

Eyes opening:

4) Spontaneous
3) To voice
2) To pain
1) No Response

Verbal response:

5) Orientated
4) Confused
3) Inappropriate words
2) Incomprehensible sounds
1) No verbal response

Motor response:

6) Obeys commands
5) Localizes to pain
4) Withdraw from pain
3) Abnormal flexion
2) Abnormal extension
1) No response

Question 16

What are the three sections of the CGS

Answer 16

Eyes (4), Verbal response (5), Motor response (6)

Question 17

Decorticate posturing

Answer 17

Abnormal Flexion:

Indicates ? damage to cerebral hemispheres, the internal capsule, and the thalamus.

sign of severe brain damage, and may also indicate lesion(s) in the lower brainstem.

Normally people displaying decorticate or decerebrate posturing are in a coma and have poor prognoses, with

risks for cardiac arrythmia or arrest and respiratory failure.

Question 18

Decerebrate posturing

Answer 18

Abnormal Extension:

lesions or compression in the midbrain lesions in the cerebellum.

Progression from decorticate posturing to decerebrate posturing is often indicative of tonsilar brain herniation.

Question 19

What do you asssess pupillary response for

Answer 19

PEARRLA

pupil, equal, round, reactive to light and accommodation

pupil size

Question 20

Exposure

• what are you looking for?

Answer 20

Needle marks
Wounds
Abrasions
Snake bites/poisons
Anything else

Question 21

What is a TBI

Answer 21

‘….alteration in brain function, or other evidence of brain pathology, caused by an external force, which can affect the scalp, skull or brain.’ (Aitken et al p585)

Question 22

TBI Classification

Mild

Answer 22

GCS 13- 15

Concussions – sports trauma

Dizziness, confusion, vomiting 4hrs

CT head recommended

Question 23

TBI Classification

Moderate

Answer 23

GCS 9-12

CT Head and 24hr in-hospital observation (Minimum)

Question 24

TBI Classification

Severe

Answer 24

GCS<8

Resuscitation

Question 25

when do pts require intubation

Answer 25

if GCS is less than 8 - pts can not maintain airway