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Pediatrics-MJ > T3: Neurological PPT > Flashcards

T3: Neurological PPT Flashcards

1
Q

Infants and young children are at higher risk for injury to the brain and spinal cord because of _____

A

Developing bones and muscles

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2
Q

Infant: Head is ___ in proportion to body (top heavy)

A

Large

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3
Q

Infant: How are neck muscles?

A

Poorly developed

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4
Q

Infant: How are the thin cranial bones?

A

Not well developed; unfused sutures

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5
Q

Infants: Skulls expands until age __

A

2 years

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6
Q

Infants are prone to brain injury and skull fracture with ___

A

Falls

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7
Q

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?

A

High cervical spine injury at C1-C2 level or vertebral compression fractures with falls

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8
Q

Moro reflex

A

Startle

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9
Q

Walking reflex

A

Stepping

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10
Q

Plantar reflex

A

Stroke foot and toes curl

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11
Q

Babinski reflex

A

Stroke side of feet ad toes fan out

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12
Q

Galant reflex

A

Infant swings to the side that is stroked

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13
Q

Tonic neck

A

Fencing

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14
Q

Cranial valute finite

Brain?
CSF?
Blood?

A

Brain: 80%
CSF: 10%
Blood: 10%

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15
Q

A change in one of these % [brain (80%), CSF (10%), or blood (10%)] means another change has to occur. True or False?

A

True

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16
Q

T/F: Infants handle increased ICP better than adults

A

True

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17
Q

ICP Signs: Headache on _____, in the absence of ____

A

Awakening, eating

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18
Q

ICP signs: What are some other signs?

A
  • Vomiting
  • Personality changes
  • Irritability
  • Fatigue
  • Gait changes
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19
Q

ICP signs: What kind of vision?

A

Double or blurred, pupils react more slowly then dilate and come fixed

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20
Q

ICP signs: Is seizure a sign?

A

Yes

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21
Q

ICP signs: What kind of head circumference? What kind of fontanels?

A

Increased head circumference, bulging fontanels

22
Q

ICP signs: How does LOC change?

A

Sleepy then to coma

23
Q

ICP late signs: What are the parts of Cushing’s Triad?

A
  • Bradycardia
  • High BP
  • Slow breathing
24
Q

ICP-late signs: What happens with Bradycardia?

A

Widening pulse pressure; slow HR

25
Q

ICP: late sign–Increased or decreased BP?

A

Increased

26
Q

ICP: late sign- Regular or irregular breathing?

A

Irregular

27
Q

A Glascow Coma Scale of ____ or less indicates poor outcomes

A

8 or less

28
Q

What are the levels of consciousness for LOC?

A
  • Lethargy
  • Obtunded
  • Stupor
  • Coma
  • Persistent Vegetative stage
29
Q

What happens with lethargy?

A

Falls asleep quickly

30
Q

What happens with obtunded?

A

Arousable with stimulation

31
Q

What happens with stupor?

A

Deep sleep, responds to vigorous, repeated stimulation

32
Q

What happens with coma?

A

No response or decerebrate posturing to pain

33
Q

What happens with persistent vegetative state?

A

Eyes open, limbs, spastic, no words, some swallow

34
Q

Come + apnea =?

A

Brain death

35
Q

Brain death is absent ____ function. How are pupils? What is the oculovestibular response? Any reflexes?

A

Absent brainstem fucntion

Pupils= fixed, dilated

No oculovestibular response

No reflexes

36
Q

Brain death: are you hypothermic?

A

No

37
Q

Brain death: Are you hypertensive?

A

No

38
Q

How is brain death determined?

A

2 EEGs and 2 exams, 24 hours apart

39
Q

Physical exam: What are the most important aspects?

A

V/S

40
Q

PE: What does pinpoint pupils mean?

A

MSO4 or poisoning

41
Q

PE: What does fixed and dilated pupils mean?

A

Brain herniation

42
Q

Is brain herniation a medical emergency or a short ED visit?

A

Medical emergency!

43
Q

PE: What does unilateral fixed and dilated pupil?

A

Lesion on the same side; impending herniation

44
Q

PE: What is Doll’s Eye Assessment?

A

Unconscious child

45
Q

What is decorticate positioning?

A

Cerebral cortex–above the brainstem

Turn in toward the cord

46
Q

What is decerebrate positioning?

A

Midbrain or brainstem problem–limbs turn out

47
Q

Moro, tonic, and withdrawal are normal as a baby. Is this a normal sign for an older child too if they have those reflexes?

A

No, poor sign!

48
Q

Unconscious child: ABC–how often do we suction if the are intubated?

A

ONLY as needed

49
Q

What does ICP monitoring do?

A

Tells amount of pressure build up in the head

50
Q

How is ICP treated?

A

Mannitol and steroids

51
Q

For ICP how should the positioning of child be?

A
  • Avoid neck compression
  • Keep head midline
  • HOB elevated
52
Q

What is the last sense to be lost with coma?

A

Hearing

Pediatrics-MJ (61 decks)

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