neurosurgery Flashcards
What are the 3 main catagories involced with GSC
What does GCS stand for
What is the best GCS to have
Motor response
Verbal response
eye opening
Glascow Coma Scale
15
At what GCS do you intubate someone
less than 8
What is the initial intervention to those with a headache AFTER a bleed is ruled out
What if they are pregnant
Ketoralac
Tylenol & Reglan
What is the mortality associated with severe head trauma
40% in the first 48 hours
What is generally first line for seizure prophylaxis
Keppra
(Levetericitam)
What are the H bombs you want to avoid with head trauma
Hypotension
hypoxia
hypo/hypercarbia
hyper/hypoglycemia
hypo/hyperthermia
How is an epidural hemorrage described
Uncal herniation
-pt. had initial LOC followed by a lucid period and then rapid decline
-ipsilaterl CN3 palsey & contralateral hemiparesis
Who is most likely to get a subdural hematoma
Eldery
can cross suture lines
Where are aneurysms most likely located
Bifurcations (circle of willis)
What type of bleed indicates an LP
Subarachnoid
What bp needs to be maintained with a subarachnoid bleed
What is first line med to maintain BP
<140/80
Labetalol
When to image someone with a concussion (adults)
For kids?
those >65
>2 episodes of vomiting
Seizure
intoxication
Focal deficit
anticoagulated
basilar skull injury evidence
dangerous mechanism
PECARN
What defines increased ICP
> 22 for 5+ minutes
What is cushing triad
Irregular breathing
bradycardia
hypotension
What is the most common type of brain herniation
Uncal (transtentorial): temporal lobe compresses the upper brainstem
What is the first line treatment for those going through alcohol withdrawal and why
Phenobarbitol because they are at high risk for seizure
What is FAST-ED and when is it used
Facial palsy
Arm weakness (look for arm drop)
speech changes
eye deviation
denial/neglect
*used for initial stroke eval before CT to get a baseline
What cheif complaint gets a hints exam
What does it stand for
Dizziness
Head impulse, nystagmus, test of skew
What does head impulse test check for
What if they have “dolls eye” result
Checks for central vs peripheral
Peripheral cause
What does verticle nystagmus indicate
Wernickes encephalopathy
Which type of vertigo will have a positive test of skew
Central vertigo
What is status epilepticus
Siezure that lasts longer than 30 min (textbook answer)
Clinically if it lasts longer than 5 minutes or if the patient does not fully recover between seizures (real life)
What is post ictal
A tired, fatigued, agitated, and Todd’s paralysis can be seen after a seizure
What is the maximum number of times benzos can be given for a seizure
Which one?
How can it be delivered
benzodiazepines
Diazapine
IV, rectal, intranasal, IO
At what BAC does alcohol withdrawal occur
IT DEPENDS
What leads to hepatic encephalopathy
Ammonia buildup
What is Asterixis
a clinical sign that describes the inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements
What causes SBP
What is SBP
when bacteria that normally live in the intestine enter the abdominal cavity and the ascites becomes infected.
Spontaneous bacterial peritonitis
Why is lactulose helpful in those with alcohol withdrawal
Binds to ammonia
What is the screening for alcohol withdrawal
CIWA
What are the two main differences b/n MS and guillian-Barre
MS is central and effects oligodendrocytes
GB is a peripheral disease and effects the Schwann cells
