Test 3 Flashcards
If O2 goes down what do vessels do
Vasodilate
If O2 goes up what do vessels do
Constrict
Is a knife low or high velocity
Low
Most common skull fracture
Linear
What type of fracture looks like you cracked an egg
Comminuted
What is the halo effect
When blood encircled by a yellowish stain is seen in dressing or bed linen
What is battles sign
Bruising behind the ear
Clinical presentation of basilar fracture
Battle sign and raccoon eyes
Potential infectious complication of basilar fracture
Meningitis
Examples of focal primary brain injuries
Contusions, hematomas, penetrating injuries
Example of diffuse primary brain injury
Diffuse axonal injury
Recovery with diffuse axonal injury
No or minimal recovery
What type of bleed is epidural hematoma
Usually arterial, may or may not be able to stop
What type of bleed is subdural hematoma
Venous, slow bleed
Most common secondary brain injury
Cerebral ischemia
Outcome with secondary brain injury
When secondary injury takes hold it is hard to resolve
Components of cranial vault
Brian tissue, blood, CSF
Normal ICP
0-15 mmHg
Increased ICP?
20 mmHg of greater from more than 5 minutes
What is the Monroe Kellie Hypothesis
Increase in any component requires decrease in one or both of other components to maintain ICP
Neuro #1 priority
Oxygenated blood to brain cells
Is herniation a early or late sign
Late
Best tool for objective assessment of LOC
Glasgow coma scale
Components of Glasgow coma scale
Eye opening, verbal response, motor response
Early signs neurological change of increased ICP
LOC change, weakness
Late signs of neurological changes of increased ICP
Stupor, coma, pupil changes (non responsive), posturing
Early vital sign change of increased ICP
Hypertension
Late vital sign change of increased ICP
Cushings triad
- systolic Hypertension with widening pulse pressure
- bradycardia
- irregular respirations
What is Cushings triad
- systolic Hypertension with widening pulse pressure
- bradycardia
- irregular respirations (sign of irreversible damage)
With what Glasgow coma scale score do we indicate ICP monitoring
3-8
CPP=
CPP=MAP-ICP
Normal CPP
70-100 mmHg
Examples of osmotic diuretics
Mannitol and hypertonic saline 3%
Normal serum osmolality
275-295 mOsm/L
2x normal sodium
What is Nicardipine
Calcium channel blocker can be used to control hypertension without effecting cerebral vasculature
3 types of incomplete lesions
Anterior cord syndrome, central cord syndrome, and Brown-Sequard syndrome
C1 to C3 usually
Ventilator dependent
PCO2 is a potent ________
Vasodilator
Hallmark early sign of shock in pediatric patients
Tachycardia
Late sign of shock in pediatric patients
Hypotension
What is Kehrs sign
Left shoulder pain from diaphragm injury in spleen injury in children
Trajectories of women in penetrating trauma? Men?
Women-downward
Men-upward force
What lobe would memory and hearing loss relate to
Temporal
What lobe has the primary functions of thinking, planning, judgment?
Frontal
What lobe has the primary function of sensory function
Parietal
What type of posturing when a patient has rigid extension and pronation of arms and legs
Decebrate
Normal GFR
80-125 ml/min
What is the GFR
How fast are the kidneys able to filter our blood
Normal phosphorus
2.4-4.1
Normal magnesium
1.5-2.5
How much of the cardiac output goes to the kidneys
20-25%
Afferent vs. efferent
Afferent- in toward a system
Efferent- out away from a system
ADH and aldosterone deal with what
Water reabsorption
What happens if patient is acidotic
Kidneys form ammonia and excrete extra hydrogen ions
What happens if a patient is alkalotic
Increased bicarb excretion
What is enuresis
Kid pees the bed at night
Hallmark signs of AKI
Azotemia and oliguria
A sudden decline in function resulting in disturbances of fluid, electrolyte, and acid-base balance
Acute Kidney Injury
What is azotemia
Increased BUN and creatinine
What is oliguria
Urine output of less than 0.5 ml/kg/hr
When a child is less than 2 can they not be potty trained
Not neurologically developed enough to control bladder
What is the most common cause of AKI in critical care patient
Sepsis
Causes of AKI
Prerenal, intrarenal, postrenal
Prerenal cause AKI
Before the kidney and it is a perfusion issue
Intrarenal causes of AKI
In the kidney, act on kidney tissue, acute tubular necrosis most common, contrast induced nephropathy is another cause
Most common cause of intrarenal AKI
Acute tubular necrosis
What kind of cause is contrast induced nephropathy
Intrarenal cause
Drug to protect kidneys from dye
Mucomyst
Postrenal causes of AKI
Obstruction of some sort, urine is sitting in kidney so increased intratubular pressure=decreased GFR, hydronephrosis
What are the three phases of AKI
Imitation, maintenance, recovery
In what stage is intrinsic renal damage established
Maintenance phase
How long may recovery phase take in AKI
4-6 months
Normal BUN/creatinine ratio
10:1-20:1
Normal creatinine clearance
84-134 ml/min
Normal GFR
80-125 ml/min
What is the GFR
How fast are the kidneys able to filter our blood
Normal phosphorus
2.4-4.1
Normal magnesium
1.5-2.5
How much of the cardiac output goes to the kidneys
20-25%
Afferent vs. efferent
Afferent- in toward a system
Efferent- out away from a system
ADH and aldosterone deal with what
Water reabsorption
What happens if patient is acidotic
Kidneys form ammonia and excrete extra hydrogen ions
What happens if a patient is alkalotic
Increased bicarb excretion
What is enuresis
Kid pees the bed at night
Hallmark signs of AKI
Azotemia and oliguria
A sudden decline in function resulting in disturbances of fluid, electrolyte, and acid-base balance
Acute Kidney Injury
What is azotemia
Increased BUN and creatinine
What is oliguria
Urine output of less than 0.5 ml/kg/hr
When a child is less than 2 can they not be potty trained
Not neurologically developed enough to control bladder
What is the most common cause of AKI in critical care patient
Sepsis
Causes of AKI
Prerenal, intrarenal, postrenal
Prerenal cause AKI
Before the kidney and it is a perfusion issue
Intrarenal causes of AKI
In the kidney, act on kidney tissue, acute tubular necrosis most common, contrast induced nephropathy is another cause
Most common cause of intrarenal AKI
Acute tubular necrosis
What kind of cause is contrast induced nephropathy
Intrarenal cause
Drug to protect kidneys from dye
Mucomyst
Postrenal causes of AKI
Obstruction of some sort, urine is sitting in kidney so increased intratubular pressure=decreased GFR, hydronephrosis
What are the three phases of AKI
Imitation, maintenance, recovery
In what stage is intrinsic renal damage established
Maintenance phase
How long may recovery phase take in AKI
4-6 months
Normal BUN/creatinine ratio
10:1-20:1
Normal creatinine clearance
84-134 ml/min