Neurology Flashcards
What is Cushing’s Triad?
- Bradycardia
- Widening Pulse Pressure
- Respiratory arrest or decreased RR
What is the normal ICP?
0-15
Increased > 20
What is CPP?
Cerebral perfusion pressure
CPP = MAP- ICP
Target is 60-80
What is the inverse relationship between MAP and ICP?
A decreased MAP = vasoconstriction = increased ICP
An increased MAP = vasodilation = decreased ICP
A map of 60 = cerebral ischemia
A map of 140 or
The management of head injuries focuses on optimizing perfusion, i.e. Minimizing ICP and maximizing CPP.
Explain auto regulation in regards to CPP and ICP
An increase in CPP causes vasoconstriction and decreases ICP
An increase in metabolism will cause an increase in cerebral blood flow and an increased ICP. What are some causes of this?
Fever
Acidosis
High PaCo2
Low PaO2
Of a patient has increased ICP you should keep what height of bed?
30 degrees
To minimize ICP you what to keep the PaO2 and the PaCO2 at what levels?
PaO2- >80
PaCO2 - 35-45
What is the average CPP?
> 60-80
When would you drain the ICP?
If it was > 20
The management of a subacute/chronic hematoma differs from epidural hematomas and acute hematomas by which intervention?
You want the HOB flat for 1-2 days
If patient has an ischemic stroke and receives TPA what should the BP be maintained under?
Don’t treat BP unless greater than 185/110
Treat with labetolol and hydralazine
If patient has ischemic stroke and does not receive TPA where will you allow the BP to go before treatment?
Treat of >220/120
A 90 year old patient presents to the ED with aphasia and right hemiparesis. LSK was 12 hours ago. Her BP is 195/105. Which medication do you anticipate the physician team will order first?
A. Labetolol 10mg IV to lower BP
B. TPA 0.9 IV over 60minutes
C. Aspirin 325mg PO
D. Aspirin 325 mg rectally
D
This is often described as the worst headache of a patients life. They get nuccal rigidity N/V
SAH
This causes disorientation, increased ICP, N/V and cranial nerve deficits
ICH
Goal BP management with SAH is a BP under what?
BP control SBP
If a SAH patient develops change in my weakness, Parasthesia or headache what is your concern?
Vasospasms treat with Nimodipine
What causes hydrocephalus after a SAH?
Blood in the SAS can mix with CSF and block the arachnoid villa which reabsorb CSF in the brain
This type of seizure causes impaired responsiveness, minimal motor involvement, and lasts
Absence seizures
This seizure causes a sudden shock like muscle contraction
Myoclonic
This seizure causes a sudden drop with loss of muscle tone and brief loss of consciousness
Atonic seizures
This part of a seizure causes increases muscle tone in extensor muscles
Tonic
This part of the generalized seizure causes limb jerking
Clonic
What is the dosage and medication for seizures?
Ativan (lorazepam) 2mg IVP q1min up to 8mg
If a tumor is located occipital. What sensory aspect is affected?
Vision
If a tumor is in the cerebellum, what affects would you expect?
Ataxia and coordination
If a tumor is in the brain stem what affects would you see?
Nausea, vomiting, CN defects, respiratory
If the tumor is pituitary what would you expect to see?
Acromegaly, Cushing’s
If the tumor is frontal what would you see?
Motor, speech and behavior and affect
If the tumor is parietal what would you expect to see?
Numbness and sensory loss and decreased special orientation
If the mass is temporal what would you expect to see?
Seizures, receptive aphasia
If the tumor was in the ventricles what would you expect to see?
HA, hydrocephalus, changes in LOC
CPP can be maintained by doing which 2 things?
Increase MAP
Decrease ICP
