ped neuro

Question 1

brain stem assessment

Answer 1

• cranial nerves
• resp pattern
• hemodynamic response to internal and external stimuli (** peds less likely to mount a bradycardia in cushings triad)

Question 2

critically low CPP in peds

Answer 2

40mmHg

Question 3

PaCO2 goal is TBI

Answer 3

35-40

Question 4

PaO2 goal in TBI

Answer 4

PaO2 > 80 < 100

Question 5

Hgb in TBI in peds

Answer 5

> 7 g/dl

Question 6

anti seizure meds in TBI peds

Answer 6

Benzos followed by

more than 1 episode
phenytoin
or
keppra

Question 7

what to monitor to ensure adequate cvp

Answer 7

U/O 1ml/kg/hr, BUN, serum Cr, exam

Question 8

what is fluid maintenance in ped TBI

Answer 8

75% maintenance

Question 9

effects of mannitol

Answer 9

osmotic diuresis which results in reduced blood viscosity

Question 10

HTS dose

Answer 10

bolus. 1-5ml/kg over 5 min
infusion?
avoid Na > 160 osmolality > 360

Question 11

second line ICP management

Answer 11

bicarb
hypervent (28-34)
hypothermia (32-34)
higher level of osmotherapy
***VERY INDIVIDUALIZED

Question 12

meningitis Dx

Answer 12

Definitive:
supportive:

Question 13

status epilepticus

Answer 13

continuous tc seizure with LOC > 5 min, 30 min = established status epileptics, 60 = refractory

Question 14

causes of status epilepticus

Answer 14

• acute CNS infection
• electrolyte
• anoxia
• mass
• med non-compliance
• antiepilectic OD
• toxin

Question 15

Seizure manegement algorythmn

Answer 15

NO IV
Lorazepam Sl/PR 0.1 mg/kg (max 4mg)
OR
Midaz SL 0.5mg/kg (max 10) or IN 0.2mg/kg

IV
midaz .1mg/kg (max 5mg < 5yrs, max 10mg >5yrs) over 2min x2

after 10min
-fosphyentoin IV or IM 20mg phenytoin/kg in NS (max 100) over 5-10min
can be given IM
***OR KEPPRA

Question 16

refractory status

Answer 16

unresponsive 2 anti-epileptic

• keppra infusion or midaz infusion

ketamine pr propofol infusion

Question 17

common cause of status

Answer 17

• inital inadequate benzo dosing
• Tx with > 2 doses of benzos
• delaying intubation or infusion