part 3

Question 1

What is the primary concern of the comatose child?

Answer 1

airway management

Question 2

Respiratory Management in the Comatose Child:

What will cause irreversible brain damage?

Answer 2

cerebral hypoxia lasting >4 minutes

Question 3

Respiratory Management in the Comatose Child:

What does CO2 retention cause?

Answer 3

vasodilation
increased cerebral blood flow
increased ICP

Question 4

Respiratory Management in the Comatose Child:

What reflexes may be minimal?

Answer 4

gag and cough reflexes minimal

-leading to risk of aspiration of secretions being increased

Question 5

What are the 4 indications for ICP monitoring?

Answer 5

• glasgow coma scale score less than 8
• TBI with abnormal CT scan
• deteriorating neurologic condition
• subjective judgment regarding clinical appearance and response

Question 6

What are the 4 types of ICP monitors?

Answer 6

• intraventricular catheter
• subarachnoid bolt (richmond screw)
• epidural sensor
• anterior fontanel pressure monitor

Question 7

What do we need to keep in mind when positioning a pt with increased ICP?

Answer 7

• avoid neck vain compression
• provide alternating pressure mattress
• elevate HOB 30 degrees

Question 8

What environmental factors do we need to consider for a pt with ICP?

Answer 8

• avoid activities that may increase ICP
• eliminate environmental noise
• only use suction to clear the airway

Question 9

What is neural tube deficit (NTD)?

Answer 9

• failed closure of neural tube around 4th week gestation

- may involve the entire length of the neural tube or a small portion