Neurological Emergencies Flashcards
The Monroe Kelli Doctrine states that we have what percentage of each in our Brain? Brain, CSF and blood? It also states that they must remain relatively equilibrium with each other.
80% brain matter
40% blood
10% CSF
What is a deep tendon test that can be performed on the bottom of the foot?
Babinski Reflex test
What is the leading cause of death in trauma?
Head injuries
What are 3 common symptoms with Meningitis?
Throbbing, progressing headache
Photophobia (sensitive to light)
Nuchal rigidity (neck stiffness)
Which form of Meningitis spreads the quickest?
Bacterial
What is Kernig’s sign?
Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to a 90 degree angle
What is the Brudzinki’s sign?
Involuntarily lifting the legs when lifting the head
What is a normal Mean Arterial Pressure?
70-110 mmHg
What is normal intracranial Pressure (ICP)?
0-15 mmHg
20 mmHg has a high mortality rate
What is a normal Cerebral Perfusion Pressure?
70-90mmHg
Minimum pressure to perfuse brain must not go below 70
What is the formula to calculate the mean arterial pressure (MAP)?
DBP +1/3 pulse pressure (SBP -DBP)
or
(2xDPB) +SBP / 3
What is the formula to calculate Cerebral Perfusion Pressure?
MAP - ICP
When monitoring ICP, where should the transducer be placed?
Approximately at the tragus (middle cartilage) of the ear
What is a diastatic skull fracture?
Occurs along the suture line, causing a widening or separation. Most often seen in infants or pediatrics
What is a unique risk of using air to transport a depressed skull fracture?
Pneumocephalus
What is a linear Fracture?
Multiple fractures radiating away from point of impact.
What is a sign of a basilar skull fracture?
Raccoon eyes or battle sign
Describe the different LeForte fractures?
LeForte I is horizontal across the maxilla where the maxillary teeth are moveable.
LeForte II is the bridge of the nose and around the mouth
LeForte III Craniofacial disassociation
Are subdural hematomas venous or arterial bleeds?
Venous
Are epidural hematomas arterial or venous bleeds?
Arterial
What are more common, Epidural or subdural hematomas?
Subdural are 6x more common
Epidural hematomas are described to be in what shape?
Lenticular in shape
What type of injury is described as having a loss of consciousness, brief lucid interval and a 2nd episode of LOC?
Epidural Hematoma
What type of brain injury shows up on a CT in a starfish pattern?
Sub-Arachnoid Hemorrhage
What is the complaint heard from patient’s when they have a sub-arachnoid hemorrhage?
The worst headache of their life
What is Cushing’s Triad?
Hypertension, bradycardia and irregular respirations
What are some clinical findings in patient’s with rising ICP?
Decreased LOC Pupil reaction Posturing Changes in vital signs Cushing's Triad
Describe anterior cord syndrome?
Motor paralysis below the level of the injury with loss of pain and temp sensation
Describe Central cord Syndrome?
Often due to hyperextension not fractures.
Presents with greater loss of function in upper extremities than lower, with variable loss of sensation of pain or temp.
Describe Brown Sequard lesion?
Resulted by penetrating trauma accompanied by damage to all spinal tracks on the involved side. Presents with motor loss, sensation to touch proprioception and vibration loss on same side and loss of sensation to pain and temp on opposite side.
Describe spinal shock?
Temporary local neurologic condition after trauma. Typically subsides in 24-72 hours.
Describe neurogenic shock?
Temporary loss of sympathetic nervous system outflow
Hypotension with bradycardia
Warm, flushed and dry below lesion
What is considered hypertensive urgency?
Patient has extremely elevated blood pressure with no signs of end organ damage.
BP should be lowered slowly
What is a hypertensive Crisis?
Elevated blood pressure with symptoms of end organ damage
Headache, nausea/vomiting, vision changes
Creatinine and RBC’s in urine
BP should be lowered no more than 25% per hour.
What is the most common cause of encephalitis in the US?
Herpes Simplex virus
