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Year 2: Neuromuscular II > Test 1: Lecture 5, SCI in ICU > Flashcards

Test 1: Lecture 5, SCI in ICU Flashcards

1
Q

facts about ICU with neuro pts

A

most research is about pts with TBI and CVA

better outcomes if hemodynamically stable

minimal research about SCI in ICU

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2
Q

important things to know about SCI pt in ICU when deciding whether or not to proceed

A

know labs/vitals

are they hemodynamically stable?

wait for surgical stabilization if needed

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3
Q

low hemoglobin and hematocrit put the pt at risk of what

A

anemia

bleeding out

need for transfusion

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4
Q

normal Hb values

A

male = 14-17 g/dL
female = 12-16 g/dL

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5
Q

critical Hb value

A

<6.5 g/dL

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6
Q

normal Hct values

A

male = 40-51%
female = 36-47%

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7
Q

critical value for Hct

A

<20% or >56%`

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8
Q

no exercise values for Hb and Hct

A

<8g/dL for Hb

<25% for Hct

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9
Q

light exercise values for Hb and Hct

A

8-10 g/dL for Hb

> 25% for Hct

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10
Q

resistive exercise values for Hb and Hct

A

> 10 g/dL for Hb

> 35% for Hct

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11
Q

what is the risk involved with an INR (international normalizing ratio) that is too high

A

risk of bleeding out

do not mobilize if too high

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12
Q

normal INR values

A

0.8-1.2

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13
Q

what INR value is safe for eval and regular exercise program with no increase in exercise intensity

A

<4.0

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14
Q

what INR value range indicates the pt should only do light exercise and NO resistance

A

4.0-5.0

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15
Q

what INR value range indicates that you should hold therapy

A

5.0-6.0

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16
Q

what INR value indicates pt should be on bedrest

A

> 6.0

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17
Q

what is the risk of a MAP value that is too low

A

too low means there is not enough pressure in the system to perfuse organs including the brain

risk of anoxic brain injury

do not mobilize if too low; may need pressors prior to mobility

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18
Q

normal MAP value

A

70-105 mmHg

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19
Q

low MAP value

A

<60 mmHg

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20
Q

what BP related issue is common among SCI pts

A

hypotension

especially with higher lvl injuries

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21
Q

risks of BP that is too low or too high with SCI pts

A

patient may become unresponsive if too low

if too high, (i.e. AD) they may have a stroke

position pt to increase BP if orthostatic and do not mobilize if resting BP is in HTN emergent category because exercise will just further increase BP

22
Q

HTN values for each stage (pre, stage I, stage II)

A

pre = 120-139 / 80-89

stage 1 = 140-159 / 90-99

stage 2 = 160-179 / 100-109

23
Q

HTN emergency values

A

> 180 / >110

24
Q

orthostatic hypotension indications

A

SBP drops >20 mmHg

DBP drops > 10 mmHg

25
Q

risks if HR is too high or low

A

too low = unresponsive

too high = cardiac event

consider before mobility; know how much their HR can increase safely with mobility based on the diagnosis

26
Q

HR values for bradychardia, normal, and tachycardia

A

brady = <60

normal = 60-100

tachy = >100

27
Q

SpO2 risks for SCI pts

A

too low = hypoxic and risk of anoxic brain injury

may need to supplement O2 to prevent desaturation with mobility

28
Q

normal, low normal, and hypoxemia SpO2 levels

A

normal = 95-100%

low normal = 90-95%

hypoxemia = <90%

29
Q

risks for abnormal RR

A

could impact gas exchange

if someone is mechanically ventilated with RR of 20 at rest they do not have much reserve to tax pulmonary system; may need higher vent settings to mobilize

30
Q

bradypnea, normal, and tachypnea values

A

bradypnea = <12

normal = 12-20

tachypnea = >20

31
Q

early medical management for SCI

A

immobilize

intubate (with minimal extension) if cervical level

screen secondary injuries

imaging = MRI, CT, Xray

spinal stabilization and decompression

32
Q

when is spinal stabilization sx best

A

first 24 hours has better outcomeds for B, C, and D

33
Q

pharmacological management for neuroprotective and BP management benefits in SCI pts

A

Neuroprotective = corticosteroids (methylprednisolone) to decrease vasogenic edema, increase SC blood flow, and decrease inflammation

neuroprotective needs to be given in first 8 hours; can cause harm past 48 hours

vasopressors to keep BP up

34
Q

common concomitant injuries

A

depends on injury mechanisms

TBI
fxs
vertebral artery injuries
integumentary compromise
organ damage

35
Q

C-collar types

A

Miami J

Aspen Vista

Halo (for upper cervical)

36
Q

TLSO bracing types

A

clamshell

others

37
Q

what is an arterial line

A

measures arterial BP in real time

goes directly into artery

often in wrist but can be in femoral aa

more accurate than BP cuff

38
Q

art line considerations for mobility

A

heavy bleeding if pulled

physician places it

may limit wrist or hip movement (i.e. UE use of AD or limited hip flexion so cannot sit)

39
Q

what is a central venous catheter

A

usually in neck

goes down large vein through vena cava into R atrium

can deliver meds directly into circulation

40
Q

what is a PICC line

A

peripherally inserted into vein and goes directly to heart

often used in pts who need long course of antibiotics

41
Q

mobility considerations for PICC line/central line

A

they insert into heart - DO NOT PULL

may cause arrthmias

may cause pneumothorax

often most efficient IV access points; med delivery is more challenging if pulled

42
Q

when do pts get tracheostomy

A

if on vent for more than 14-21 days

tube transferred from mouth to hole in neck directly into trachea

43
Q

vent mobility considerations

A

vents are not portable; call RT if need to move so they can be bagged

high likelihood of desaturation- watch SpO2

high risk of barotrauma if vent settings too high

consider buffer room and if pt settings can be safely turned up before risk of other complications when doing mobility

44
Q

catheter mobility considerations

A

hurt a lot when pulled bc of balloon and may be bleeding

gravity dependent

45
Q

how are vents controlled

A

either by pressure or volume

46
Q

what is peak pressure on a vent

A

pressure in lungs during inhalation

47
Q

plateau pressure on vent

A

pressure in lungs when air stopped moving

48
Q

what is FiO2

A

fraction of inspired O2

normal RA is 21%

max is 100%

49
Q

what is flow rate

A

how quickly volume is being delivered (L/min)

50
Q

what is PEEP

A

positive end expiratory pressure

pressure required to keep alveoli open for gas exchange

5-10 range is more typical for mobility

51
Q

how to do upright trials in ICU

A

progress to 1 hour upright

start at 15 min and progress by 15 min each session

tilt every 15 min for 2 min

check virals at every position change

check skin pre- post- mobility

52
Q
A

Year 2: Neuromuscular II (18 decks)

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