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Specialized Pharmacology MN650 > Neurological Trauma > Flashcards

Neurological Trauma Flashcards

1
Q

How does injury occur in an acceleration/deceleration injury?

A

compression, tension and shearing injuries

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2
Q

name for brain tissue injury directly at the site of impact and at teh pole opposite of the site of impact?

A

coup-countrecoup injury

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3
Q

Blast injuries primarily affect which part(s) of the brain?

A

hippocampus and brain stem

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4
Q

How does hyperventilation lower ICP?

A

causes cerebral vasoconstriction

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5
Q

When is hyperventilation used in the treatment of a brain injury?

A
  • when symptoms of brain herniation are present or if ICP is severely high
  • causes vasoconstriction by reducing PaCO2
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6
Q

What is the goal PaCO2 when hyperventilating a patient with suspected herniation?

A

25-30 mmHg

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7
Q

What is the goal SBP for 50-60 y/o with brain injury?

A

> 100 mmHg

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8
Q

What is the goal SBP for > 15 y/o with brain injury?

A

> 110 mmHg

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9
Q

What does AVPU stand for when assessing neuro status?

A
  • Awake
  • responds to Verbal stimuli
  • responds to Painful stimuli
  • Unresponsive
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10
Q

What does the glasgow coma scale assess?

A
  • eye opening
  • verbal response
  • motor response
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11
Q

What is the score range for the GCS?

A
  • 3-15
  • 3 = worst score
  • 15 = best scores
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12
Q

A patient is considered comatose with a GCS score of?

A

8 or less

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13
Q

Term for flexion of upper extremities with inward rotation and extension of lower extremities

A

decorticate

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14
Q

term for rigidity and abnormal extension of upper extremities and lower extremities

A

decerebrate

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15
Q

What condition should be considered when pupils are sluggish, unequal or enlarged with no response?

A

increased intracranial pressure or herniation

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16
Q

What labs should be drawn on a TBI patient?

A
  • tox screen
  • CBC
  • BMP or CMP
  • Coagulation panel
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17
Q

What is the initial imaging study for a TBI patient?

A

non-contrast CT

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18
Q

What are the categories of injury related to TBI?

A
  • primary head injury
  • skull fracture
  • brain injury
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19
Q

What is the most common head injury?

A

scalp laceration

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20
Q

What are signs of hypolemia?

A
  • increased HR

- decreased BP

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21
Q

How to treat a scalp laceration?

A
  • monitor for hypovolemia
  • assess for skull fracture then apply direct pressure
  • suture/staple
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22
Q

Lidocaine 1% with epinephrine should not be use where on the head?

A

nose or ears

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23
Q

Types of skull fractures?

A
  • simple
  • depressed
  • basilar
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24
Q

Description of a simple skull fracture?

A

no displacement of bone or interface of the outside environment with the intracranial contents

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25
Q

Description of a depressed

A

bone tables and fragments depressing the thickness of the skull with exposure of the intracranial contents with the outside environment

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26
Q

Type of skull fracture with no displacement of bone or interface of the outside environment with the intracranial contents

A

simple skull fracture

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27
Q

Type of skull fracture where the bone tables and fragments depressing the thickness of the skull with exposure of the intracranial contents with the outside environment

A

depressed bone fracture

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28
Q

Treatment of a depressed bone fracture?

A
  • surgery often required
  • prophylactic broad-spectrum antibiotics
  • tetanus is indicated
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29
Q

Description of a basilar fracture?

A

fracture in the anterior or posterior skull base

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30
Q

Raccoon eyes are associated with which type of fracture?

A

basilar fracture with anterior skull based compartment involvement

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31
Q

Term for periorbital ecchymosis related to an anterior skull base fracture?

A

raccoon eyes

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32
Q

Term for mastoid ecchymosis related to a posterior skull basilar fracture?

A

battle sign

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33
Q

Battle sign is associated with which type of fracture?

A

basilar fracture with posterior skull base involvement

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34
Q

Signs of a basilar fracture?

A
  • raccoon eyes
  • battle signs
  • otorrhea
  • rhinorrhea
35
Q

Treatment of a basilar fracture?

A
  • lumbar drain to divert CSF and minimize ICP
  • surgical repair
  • prophylactic antibiotics
  • intubation and OG
36
Q

What are considerations for placement of a gastric tube in a patient with a skull fracture?

A
  • use oral gastric tube and intubation

- avoid nasal route

37
Q

Term for transient, reversible alteration in brain function?

A

concussion

38
Q

What is the most common location of a concussion?

A

the temporal lobe

39
Q

Consider imaging of a concussed patient if?

A
  • GCS < 15 at 2hr
  • GCS < 14 anytime
  • EtOH/drugs suspected/noted
  • concern for skull fracture
  • age > 60 or < 16
  • coagulopathy suspected
  • focal deficit
  • Loss of consciousness > 5 min
  • seizure activity noted
  • vomiting > 2 times
  • persistent, severe HA
40
Q

Term for regions of hemorrhagic necrosis and bruising of the brain

A

contusion

41
Q

Most common sites of contusion lesions in the brain?

A

orbitofrontal or anterior temporal regions

42
Q

Consider starting which types of prophylaxis treatment for brain contusions?

A

antiepileptic and seizure precautions

43
Q

Bleeding into the epidural space between the skull and dura mater is called?

A

epidural hematoma

44
Q

Lenticular shape that does not cross suture lines noted on a brain CT is indicative of?

A

an epidural hemorrhage

45
Q

Evaluation and treatment of an epidural hematoma?

A
  • noncontrast CT
  • neurosurgical consult
  • medical therapy
  • surgical intervention
46
Q

bleeding between the dura mater and arachnoid or pia layers?

A

subdural hematoma

47
Q

What is the most frequent type of intracranial bleeding?

A

subdural hematoma

48
Q

How long does it take for an Acute subdural hematoma to develop?

A

minutes to hours

49
Q

How long does it take for a chronic subdural hematoma to develop?

A

days or weeks, generally in the elderly

50
Q

Caused by the accumulation of blood between the arachnoid and pia surface?

A

subarachnoid hemorrhage

51
Q

Symptoms of a epidural hematoma?

A
  • initially unconscious, wakes up without deficit and then deteriorates
  • deterioration may be rapid
52
Q

S/S of an acute subdural hematoma?

A
  • drowsiness
  • agitation
  • confusion
  • HA
  • unilateral or bilateral pupil dilation
  • hemiparesis
53
Q

S/S of a chronic subdural hematoma?

A
  • usually in the elderly
  • HA
  • memory loss
  • personality changes
  • incontinence
  • ataxia
54
Q

S/S of traumatic subarachnoid hemorrhage?

A
  • HA
  • reduced LOC
  • nuchal rigidity
  • hemiplegia
  • ipsilateral pupil abnormalities
55
Q

Diffuse axonal injury is commonly observed with which type of movement?

A

rapid acceleration/deceleration of the head d/t shearing forces

56
Q

Mild coma r/t a diffuse axonal injury lasts?

A

6-24 hrs

57
Q

Moderate coma r/t a diffuse axonal injury lasts?

A

> 24 hrs

58
Q

Severe coma r/t a diffuse axonal injury lasts?

A

prolonged and with decorticate/decerebrate posturing

59
Q

Blown pupils are indicative of what type of brain injury?

A

cerebral herniation

60
Q

What are the signs of Cushing triad r/t TBI?

A

1 ) HTN with widening pulse pressure

2) decreased RR
3) bradycardia
- elevated ICP is a late sign

61
Q

Treatment of cerebral edema/elevated ICP/herniation?

A
  • elevate HOB > 30 degrees
  • opioids to lower ICP
  • drain CSF
  • hypothermia
  • paralysis
62
Q

Preferred choice of sedation in treatment of cerebral edema/elevated ICP/herniation?

A
  • short acting opioids
  • fentanyl
  • remifentanil
63
Q

What is the max dose of propofol for the treatment of cerebral edema/elevated ICP/herniation?

A

5mg/kg/hr

64
Q

What is the dosage for a fentanyl gtt to treat cerebral edema/elevated ICP/herniation?

A

2-5 mcg/kg/hr

65
Q

What is the dosage of propofol in the treatment of cerebral edema/elevated ICP/herniation?

A

20-75 mcg/kg/hr

66
Q

Dexmedetomidine (precedex) gtt dosage in the treamtne of cerebral edema/elevated ICP/herniation?

A

0.2-0.7 mcg/kg/hr

67
Q

Midazolam (versed) gtt dosage in the treatment of cerebral edema/elevated ICP/herniation?

A

0.2-1 mg/hr

68
Q

diazepam (valium) dosage in the treatment of cerebral edema/elevated ICP/herniation?

A

2.5-10 mg single dose

69
Q

lorazepam (ativan) dose in the treatment of cerebral edema/elevated ICP/herniation?

A

0.5-2 mg single dose

70
Q

Cisatracurium (Nimbex) dosage in the treatment of cerebral edema/elevated ICP/herniation?

A
  • 0.1-0.2 mg/kg bolus

- 1- 10 mcg/kg/min continuous

71
Q

Nimbex is titrated to?

A

train of four

72
Q

Why is Mannitol the drug of choice in an emergency situation when brain herniation is pending?

A
  • creates an osmotic gradient across the blood-brain barrier that pulls water from the CNS into the intravascular space
  • decreases blood viscosity
73
Q

Hyperosmolar therapy with Mannitol to treat brain herniation should be avoided in what patients?

A
  • in shock
  • HF
  • significant renal disease
74
Q

What does CPP stand for?

A

cerebral profusion pressure

75
Q

Prophylactic anti-seizure treatment should last no longer than how many days?

A

7 days

76
Q

How many cervical vertebrae are there?

A

7

77
Q

How many thoracic vertebrae are there?

A

12

78
Q

What are the parts of the spinal cord?

A
  • ascending tracks
  • descending tracks
  • gray matter
  • white matter
  • meningeal layer
79
Q

What are the parts of the meningeal layer?

A
  • pia mater
  • arachnoid
  • dura mater
80
Q

Types of spinal injury?

A
  • complete

- incomplete

81
Q

Types of incomplete spinal cord injuries?

A
  • Anterior cord syndrome
  • Posterior cord syndrome
  • Central cord syndrome
  • Brown-Sequard syndrome
  • Cauda equina syndrome
82
Q

Anterior cord syndrome is cause by what type of injury?

A

hyperflexion injury

83
Q

What is tested for in a BMP?

A

a. Bicarb
b. BUN
c. Creatinine
d. Calcium
e. Chloride
f. Glucose
g. Potassium
h. Sodium

84
Q

What is tested for in a CMP?

A

a. Albumin
b. Alkaline phosphatase (ALP)
c. ALT
d. AST
e. Bicarb
f. Bilirubin
g. BUN
h. Creatinine
i. Calcium
j. Chloride
k. Glucose
l. Potassium
m. Sodium
n. Total protein

Specialized Pharmacology MN650 (28 decks)

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