Pestana Wisdom Flashcards
Which measures can be use to manage/relieve increased increased intracranial pressure?
- ICP monitoring
- Elevate the head
- Hyperventilate (leads to cerebral vasocontriction)
- Avoid fluid overload
- Give mannitol (osmotic diuretic) or furosemide (loop diuretic) (BUT, avoid diuresing to the point of lowering systemic BP
- Some have proposed sedatives or cooling (hypothermia) as a way of decreasing brain activity (and thus, oxygen demand)
What are the 3 things that can cause neurological injury from brain trauma?
1) Initial blow (no tx)
2) Subsequent development of intracranial hematoma (relieve with surgery)
3) Subsequent development of increased ICP -> control medically, mannitol, hyperventilation
A common theme in cancer is that lesions that cause symptoms sooner (or those that have effective screening tests and recommendations) can be diagnosed at an earlier/less advanced stage, and are usually more survivable.
Conversely, lesions that take a long time to present will often be caught very late.
Example, head of the pancreas cancer often presents earlier because of jaundice/steatorrhea from obstruction of CBD and pancreatic duct, while body of the pancreas cancer is often caught later when it less resectable.
Lung carcinomas often don’t present with symptoms (SOB, coughing, hemoptysis, chest pain) until very advanced.
Ovarian cancers, sarcomas in the abdomen, have SO much room to grow that they don’t typically present until very large/advanced.
Colon cancer can present relatively early because it can cause obstructive symptoms/BRBPR.
Bottom line: when does the tumor cause symptoms that “announce” themselves?
What is decerebrate posture? What does it represent? When does it occur?
What GCS score would this patient receive?
EXTENSOR POSTURING - involuntary extension of the upper extremities.
Head is arched back, arms extended to the sides, and legs extended. HALLMARK = extended elbows. Signs may be unilateral or bilateral; may just be in the arms; and may be intermittent.
Score of 2 on the motor section of GCS.
Indicates BRAINSTEM damage, specifically below the level of the red nucleus. Is exhibited by people with lesions in the midbrain and lesions in the cerebellum.
Commonly seen in PONTINE STROKES.
Progression from decorticate posturing to decerebrate posturing indicates uncal (transtentorial) herniation or tonsillar brain heniation.
GAMMA MOTOR NEURONS are thought to be important for decerebrate rigidity (due to animal studies showing that dorsal root transection eliminates decerebrate rigidity symptoms).
What is decorticate posture? What does it represent? When does it occur?
FLEXOR POSTURING
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What is abnormal posturing?
An involuntary FLEXION or EXTENSION of the arms and legs, indicating severe brain injury. SEVERE MEDICAL EMERGENCY and poor prognostic indicator.
It occurs when one set of muscles becomes incapacitated (flexors vs extendors), while the opposing set is not, and an external stimulus such as pain causes the working set to contract. The posturing may also occur with other stimuli.
Posturing is a component of the Glascow Coma Scale
When brain (uncal) herniation occur (or is about to occur), will they exhibit decerebate posturing or decorticate posturing?
In herniation syndrome, decorticate posturing (FLEXION, arms flexed) occurs, and if the condition is left untreated, develops into decerebrate posturing (EXTENSION, arms extended).
What is opsithotonus?
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Spaces in the body that you can exsanguinate into?
- Abdomen
- Hemithorax (nearly)
- Retroperitoneum
- Thigh (uni- or bilateral)
- FLOOR (bleeding outside the body)
Note, hypovolemic shock/exsanguination cannot result from an intracranial hemorrhage because there isn’t enough space.
Indication for surgical exploration of the neck in penetrating trauma
Expanding hematoma
Unstable vital signs
Signs of tracheal/esophageal injury (coughing or spitting up blood)
In patients with severe blunt trauma to the neck, what is an important thing to ascertain? Which diagnostic test should you order?
The integrity of the c-spine.
In these patients, if there are neurologic deficits or tenderness to palpation over the C-spine, get AP and lateral plain films of the c-spine (including T1 vertebrae). Also, can get CT c-spine (or if getting a head CT, can extend the CT scan to include the C-spine).
What is a typical mechanism for anterior cord syndrome/injury? What are the characteristic resulting deficits?
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What is a typical mechanism for cord hemisection (Brown-Sequard Syndrome)? What are the characteristic resulting deficits?
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What is a typical mechanism for posteior cord syndrome/injury? What are the characteristic resulting deficits?
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What is a typical mechanism for central cord syndrome/injury? What are the characteristic resulting deficits?
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