Semester general review Flashcards
Afferent vs Efferent
Afferent = Brings towards AKA Sensory
Efferent = Takes away AKA motor
Why is the pyramidal tract important?
What are the primary function of the cerebellum?
- Control equilibrium
- controls muscle tone
- Controls coordination of muscle movements
What is ataxia?
Loss of muscle coordinations
5 levels consciousness
- list them is descending order of wakefulness
- Full consciousness
- Lethargy
- Obtundation
- Stupor
- Coma
Define lethargy
Pt. is drowsy but partially awakens to stimulation.
- can list and respond slowly
Define Obdundation
Pt. is difficult to arouse and needs constant stimulation to follow a simple command.
Define Stupor
Pt arouses to vigorous and continuous stimulus (painful).
- only attempts to withdraw
What nerves involve the pupillary reflexes?
CNs II and III
What nerves involve the corneal reflexes?
CN’s V and VII
Between the CNs 9 and 10, which are motor and which are sensory?
Glossopharyngeal nerve (IX) reflects the sensory reflex for gagging and swallowing
Vagus nerve (X) reflects the motor reflex for gagging and swallowing
Define Cushing triad
A late sign of increased ICP
- consists of increasing systolic BP with wide pressure (hypertension)
- bradycardia
- bradypnea/irregular respirations
-
What is Neonatal encephalopathy (NE)?
Depressed or disturbed neurological function, often caused by lack of oxygen to the baby within the first days of life.
- NE indicates an underlying neurological problem, not a condition
-
As increasing levels of benzodiazepines are given you expect which of the following effects (in order):
A) Respiratory depression, analgesia, loss of consciousness
B) Loss of consciousness, analgesia, respiratory depression
C) Analgesia, respiratory depression, loss of consciousness
D) Analgesia, loss of consciousness, respiratory depression
D) Analgesia, loss of consciousness, respiratory depression
You have assessed a patient and suspect damage to cranial nerve IX but note an intact cranial nerve X. This would be evidenced by____?
Lack of a gag reflex but cough with suctioning
What is the Glasgow Coma Scale (GCS) score that requires intracranial pressure monitoring?
Head-injured patients with GCS scores of 8 and less need monitoring of intracranial pressure.
At what level of intracranial pressure will venous drainage be impeded and cerebral edema develop in uninjured tissue?
30-35 venous drainage is impeded and edema develops in uninjured tissue
- normal ICP is 5-15
Which of the following is the most critical parameter to keep in mind when managing a patient with intracranial hypertension?
Cerebral perfusion pressure (CPP)
- Remember that although hyperventilation is associated with lower ICP values caused by vasoconstriction of brain blood vessels associated with hypocapnia, cerebral perfusion pressure (CPP) is the most critical element to monitor.
Which of the following cranial nerves is intact if cough is present while the airway is suctioned?
An intact CN X (vagus)
The presence of dorsiflexion of the great toe with fanning of remaining toes during testing of the plantar reflex is known as_____?
Babinski’s sign—is abnormal, except in children up to 12 to 18 months of age.
Pupillary response is reflected by which cranial nerves?
CN II and III
Corneal reflex is reflected by which nerve?
CN V and VII
Where in the nervous system is breathing regulated?
HR, BP, and breathing are regulated by the brainstem
What compartments does the brain consists of (3)
- The cerebrum (2 hemispheres)
- Brainstem (midbrain, pons, and medulla)
- Cerebellum (back of head + motor control)
What is the Becks Triad associated with?
Cardiac Tamponade
- Low blood pressure (hypotension)
- Bulging neck veins
- Distant or muffled heartbeats
How do you reduce pressure on the heart (tx) for cardiac tamponade?
Give O2 and elevate legs
- Pericardiocentesis (needle/catheter to drain fluid)
- Surgery
Why is Cardiac Tamponade a problem?
Cardiac tamponade occurs when fluid builds up in the pericardium, which can impair the heart’s ability to fill and cause hemodynamic compromise. Beck’s triad is most commonly caused by acute intrapericardial hemorrhage.
Sign and symptoms associated with becks triad?
Decrease BP (decreased volume of blood being pumped by the heart) which is accompanied by:
- SOB
- Increased HR
- Excessive fluid around the heart
- Cold, sweaty, pale skin
What are your Hs and Ts in ACLS?
The H’s and T’s are 12 reversible conditions that could cause PEA. 7 Hs and 5 Ts.
Hypovolemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypoglycemia
Hypokalemia
Hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade – Cardiac
Toxins
Thrombosis (pulmonary embolus)
Thrombosis (myocardial infarction)
How to identify and tx hypovolemia during ACLS?
- Rapid HR, Narrow QRS on ECG; other symptoms of low volume
- Tx with infusion of normal saline or ringers lactate
How to identify and tx hypoxia during ACLS?
- Slow HR
- Airway management and effective oxygenation
How to identify and tx hydrogen ion excess (acidosis) during ACLS?
- Amplitude QRS on ECG
- Hyperventilation; consider sodium bicarb bolus
How to identify and tx hypoglycemia during ACLS?
- Bedside glucose testing
- IV bolus of dextrose
How to identify and tx hyokalemia during ACLS?
- Flat T waves and appearance of a U wave on ECG
- IV magnesium infusion
How to identify and tx hyperkalemia during ACLS?
- Peaked T waves and wide QRS complex on ECG
- Consider calcium chloride, sodium bicarb, and an insulin and glucose protocol approach
How to identify and tx hypothermia during ACLS?
- Typically preceded by exposure to cold environment
- Gradual rewarming
How to identify and tx tension pneumothorax during ACLS?
- Slow HR and narrow QRS complexes on ECG; difficulty breathing; Trach position, b/s
- Thoracostomy or needle decompression
How to identify and tx Tamponade during ACLS?
- Rapid HR and narrow QRS
- Pericardiocentesis
How to identify and tx toxins during ACLS?
- Typically will have prolonged QT interval; and/or neurological symptoms
- Based on specific toxin
How to identify and tx thrombosis (pulmonary embolus) during ACLS?
- Rapid HR w/narrow QRS
- Surgical embolectomy or admin of fibrinolytic
How to identify and tx thrombosis (myocardial infarction) during ACLS?
- ECG will be abnormal based on location of infarction
- Dependent on extent and age of MI
Which of these drugs is used to control bronchospasm during a bronchoscopy?
A. Lidocaine
B. Midazolam
C. Atropine
D. Albuterol
D. Albuterol
Which of these drugs is used as a topical anesthetic?
A. Lidocaine
B. Midazolam
C. Atropine
D. Albuterol
A. Lidocaine
During a bronchoscopy, epinephrine is used to:
Control bleeding due to its vasoconstrictive properties
During a bronchoscopy, epinephrine is used to:
A. Lidocaine
B. Midazolam
C. Atropine
D. Albuterol
A. Lidocaine
Lidocaine can suppress the cough reflex, which is particularly useful during procedures like bronchoscopy.
Which of these is a possible use of the ice-cold saline solution during a bronchoscopy?
A. Relieve bronchospasm
B. To reduce pain and discomfort.
C. To help reduce swelling of the airways.
D. Help stop bleeding
Ice-cold saline is used for its vasoconstrictive and hemostatic properties to control bleeding during a bronchoscopy.
Why does hyperventilation reduce ICP?
Hyperventilation reduces ICP by causing hypocapnia, which induces cerebral vasoconstriction
- Decreased CPP = reduced ICP in the short term
- Remember CO2 is a vasodilator in the brain
Why is hypovolemia/shock a risk factor with infections?
What information can CVP monitoring provide?
Can provide information on the amount of circulating blood volume, the degree of venous return, and right ventricular function.
Does spontaneous inspiration increase or decrease intrathoracic pressure?
Spontaneous inspiration causes the intrathoracic pressure to drop and the CVP reading to decrease.
Why is the radial artery a popular site for arterial catherization?
It can be stabilized easily and collateral circulation is available should a clot develop
Which technique is used most commonly to insert an arterial pressure monitoring catheter?
Seldinger technique
(don’t worry about this card)
What does the dicrotic notch represent on an arterial pressure waveform
aortic valve closure, which occurs as the ventricles relax
Approximately how much blood can be lost before circulatory function and pressures are affected?
The circulatory system can tolerate as much as a 25% loss in blood volume before blood pressure begins to fall.
PEEP levels lower than what value has a limited effect on intrapleural pressure?
10 cmH2O
Blood flow is directed to organs that have the highest metabolic needs when at rest. Which of the following organs would have the lowest metabolic needs when at rest?
a) Heart
b) Liver
c) Muscles
d) Kidneys
The heart is very efficient in its use of oxygen so A
At rest, approximately what percentage of total blood volume is stored in the venous system?
64%
The venous system is very large and holds almost two thirds of the circulating blood volume at rest
What does pulse pressure reflect?
Pulse pressure reflects stroke volume and can be assessed with only the use of a blood pressure cuff
What is used to determine the afterload of the RV?
PVR is used to assess right ventricular afterload.
Indications for cool humidity
- Post extubation
- Soreness, hoarseness, or edema
- Increased secretions/cough
- URT or irritation
What medication is typically used for influenza tx’s?
Tamiflu
Indications for heated humidity
- Bypass URT
- Increased secretions
- Hypothermia
- Burn patients
- Drowning patients
- Hemoptysis
What chloride levels should you know for cystic fibrosis?
Greater than 60 confirms cystic fibrosis, less than 40 means you don’t have it
- anything in between requires more testing
what is ARDS from a pathology standpoint?
A lung injury that happens when fluid builds up in alveoli, that has no cardiac cause.
- Prevents lungs from filling with air = low O2 levels in blood (hypoxia)
How many phases does ARDS have?
3 phases (in progression order):
- exudative
- proliferative
- fibrotic
Phases describe level of inflammation and fluid buildup, and subsequent repair process that your lungs go through to heal
What does systolic pressure represent?
The pressure in the arteries during cardiac contraction (systole)
- Normal = 90-120 mmHg
What does low systolic blood pressure (hypotension) indicate? (3)
- Inadequate CO
- Reduced perfusion
- Hypovolemia
Why could be causes of inadequate cardiac output
Conditions like cardiogenic shock, heart failure, or bradycardia could cause low cardiac output
What are primary concerns if systolic pressures are low (hypotension) 2
- Syncope or dizziness due to cerebral hypoperfusion
- Organ dysfunction/failure from inadequate O2 delivery
What does high systemic blood pressure indicate? (hypertension) 2
- Increased cardiac workload
- Chronic vascular damage
What could be causes of increased cardiac workload?
Stiff arteries, excessive sympathetic activity or fluid overload
What problems could arise with high systolic blood pressure? 2
- Left ventricular hypertrophy and heart failure.
- Increased risk of hemorrhagic stroke and kidney damage.
What does Diastolic blood pressure represent
The pressure in the arteries during cardiac relaxation (filling)
- Normal = 60-80 mmHg
What does low diastolic blood pressure indicate? (2)
- Reduced vascular tone (septic shock or anaphylaxis)
- Poor coronary perfusion (Coronary arteries fill during diastole, if very low could lead to MI)
What are problems associated with low diastolic blood pressure?
Reduced coronary and organ perfusion, patients will also be fatigue and have poor tolerance due to impaired oxygen delivery
What are problems associated with high diastolic blood pressure?
end organ damage, especially to the kidneys, eyes, and brain
- increases risk of ischemic and hemorrhagic stroke
What does a wide and narrow pulse pressure mean?
Pulse Pressure (SBP - DBP)
- Normal: ~30–50 mmHg.
- Wide Pulse Pressure: May indicate stiff arteries (e.g., aortic regurgitation, older age).
- Narrow Pulse Pressure: Suggests reduced stroke volume (e.g., tamponade, severe heart failure).
What does high diastolic blood pressure indicate?
- Vascular resistance (increased systemic vascular resistance), in the cases of chronic hypertension or vasoconstriction
- Prolonged cardiac workload which could put strain on the left ventricle
What are the implications of low blood pressure (systolic and diastolic) to the:
- brain
- heart
- kidneys
Poor perfusion to organs
- Brain: Hypotension can cause ischemia, confusion, or loss of consciousness.
- Heart: Reduced coronary perfusion leads to ischemia or infarction.
- Kidneys: Hypotension results in acute kidney injury (AKI) or failure.
How does additional PEEP benefit a patient with CHF?
Peep reduces venous return (preload) and therefore the volume burden on pulmonary vasculature.
- aka allows lymphatics to catch up; letting them drain appropriately (lessens edema and fluid leaking into alveoli/interstitial space)
- Decreases workload on the heart and lungs
- Additional PEEP also aids in v/q correction bc it recruits collapsed alveoli during exhalation
What defects are usually associated with Myasthenia Gravis?
- Autoimmune neuromscular disease, autoimmune mediated destruction of ach receptors leading to…
- Chronic neurotransmission
- Diploid (double vision)
- Asymmetrical ptosis (drooping of eyelid)
