T3: Neurological PPT Flashcards
Infants and young children are at higher risk for injury to the brain and spinal cord because of _____
Developing bones and muscles
Infant: Head is ___ in proportion to body (top heavy)
Large
Infant: How are neck muscles?
Poorly developed
Infant: How are the thin cranial bones?
Not well developed; unfused sutures
Infants: Skulls expands until age __
2 years
Infants are prone to brain injury and skull fracture with ___
Falls
Infants: Excessive spinal mobility; immature muscles, joint capsuel and ligaments of cervical spine; wedge-shaped, cartilaginous vertebral bodies; incomplete ossification of vertebral bodies–all this possess greater risk for what?
High cervical spine injury at C1-C2 level or vertebral compression fractures with falls
Moro reflex
Startle
Walking reflex
Stepping
Plantar reflex
Stroke foot and toes curl
Babinski reflex
Stroke side of feet ad toes fan out
Galant reflex
Infant swings to the side that is stroked
Tonic neck
Fencing
Cranial valute finite
Brain?
CSF?
Blood?
Brain: 80%
CSF: 10%
Blood: 10%
A change in one of these % [brain (80%), CSF (10%), or blood (10%)] means another change has to occur. True or False?
True
T/F: Infants handle increased ICP better than adults
True
ICP Signs: Headache on _____, in the absence of ____
Awakening, eating
ICP signs: What are some other signs?
- Vomiting
- Personality changes
- Irritability
- Fatigue
- Gait changes
ICP signs: What kind of vision?
Double or blurred, pupils react more slowly then dilate and come fixed
ICP signs: Is seizure a sign?
Yes
ICP signs: What kind of head circumference? What kind of fontanels?
Increased head circumference, bulging fontanels
ICP signs: How does LOC change?
Sleepy then to coma
ICP late signs: What are the parts of Cushing’s Triad?
- Bradycardia
- High BP
- Slow breathing
ICP-late signs: What happens with Bradycardia?
Widening pulse pressure; slow HR
ICP: late sign–Increased or decreased BP?
Increased
ICP: late sign- Regular or irregular breathing?
Irregular
A Glascow Coma Scale of ____ or less indicates poor outcomes
8 or less
What are the levels of consciousness for LOC?
- Lethargy
- Obtunded
- Stupor
- Coma
- Persistent Vegetative stage
What happens with lethargy?
Falls asleep quickly
What happens with obtunded?
Arousable with stimulation
What happens with stupor?
Deep sleep, responds to vigorous, repeated stimulation
What happens with coma?
No response or decerebrate posturing to pain
What happens with persistent vegetative state?
Eyes open, limbs, spastic, no words, some swallow
Come + apnea =?
Brain death
Brain death is absent ____ function. How are pupils? What is the oculovestibular response? Any reflexes?
Absent brainstem fucntion
Pupils= fixed, dilated
No oculovestibular response
No reflexes
Brain death: are you hypothermic?
No
Brain death: Are you hypertensive?
No
How is brain death determined?
2 EEGs and 2 exams, 24 hours apart
Physical exam: What are the most important aspects?
V/S
PE: What does pinpoint pupils mean?
MSO4 or poisoning
PE: What does fixed and dilated pupils mean?
Brain herniation
Is brain herniation a medical emergency or a short ED visit?
Medical emergency!
PE: What does unilateral fixed and dilated pupil?
Lesion on the same side; impending herniation
PE: What is Doll’s Eye Assessment?
Unconscious child
What is decorticate positioning?
Cerebral cortex–above the brainstem
Turn in toward the cord
What is decerebrate positioning?
Midbrain or brainstem problem–limbs turn out
Moro, tonic, and withdrawal are normal as a baby. Is this a normal sign for an older child too if they have those reflexes?
No, poor sign!
Unconscious child: ABC–how often do we suction if the are intubated?
ONLY as needed
What does ICP monitoring do?
Tells amount of pressure build up in the head
How is ICP treated?
Mannitol and steroids
For ICP how should the positioning of child be?
- Avoid neck compression
- Keep head midline
- HOB elevated
What is the last sense to be lost with coma?
Hearing
