Trauma and Neurocritical Care Flashcards
NG tubes used in the critically ill neurotrauma patient give a higher rate of what complication?
However, what effect does early feeding with NGT have on death and poor outcome?
Increased risk of ventilator-associated pneumonia
Reduces risk of death and poor outcome
What are some findings on imaging which suggest towards tumefactive multiple sclerosis rather than a true neoplasm?
Partial ring enhancement, subtle deficits for size of lesion, minimal mass effect or midline shift, presence of veins on dynamic MRI
Otherwise, a relatively normal EEG and steroid responsiveness also may suggest
Ketamine is a unique anesthestic. What effect does it have on CBF and CMRO2?
Increases both of them
What is another name for traumatic encephalomeningocele?
Growing skull fracture
Or
Leptomeningeal cyst
What is the relationship between the elasticity of tissue and the amount of tissue damage done by a bullet?
Inverse
What is the most common type of infection seen post-head injury?
UTI
Why is CN VI particularly susceptible to injury during embolization of a CCF?
CN VI is relatively free floating in the cavernous sinus and is not covered up by dural folds
What is the preferred sedative of choice in pediatric severe TBI, specifically patients with high ICP, and why?
Fentanyl. It has no effect on blood pressure and oxygen saturation
Moderate to severe pediatric TBI most commonly causes what symptomatic hormonal deficiency?
Growth Hormone
Preserved mental status in combination with severe dysmetria and a rash is classic for what self-limited syndrome related to viral illnesses?
Post-infectious cerebellar ataxia. Often associated with varicella, mumps, EBV, mycoplasma
What Pa CO2 level is required to indicate brain death?
PaCo2 level of 60
In treating status epilepticus in adults what medication should be co-administered with benzodiazepines?
Phenytoin
What is one of the earliest signs of the development of malignant hyperthermia?
Rising end-tidal carbon dioxide
What circulating antibodies are found in patients with myasthenia gravis?
What are appropriate treatment options?
nACH receptor antibodies
Thymectomy, acetylcholinesterases, plasmaparhesis, steroids
How are barbiturates theorized to decrease ICP?
They reduce cerebral metabolism and couple this to cerebral blood flow
In patients with low serum sodium and osmolality with high urinary sodium what additional metric is required to distinguish SIADH from cerebral salt wasting and why?
Circulating blood volume
SIADH will have elevated circulating volume due to ADH causing retained water
CSW will have decreased because free water is being pulled out of the kidneys causing hypovolemia
What is an indication to operate on an anterior frontal wall of frontal sinus fracture?
Likelihood of cosmetic deformity
What is the appropriate intervention for tension pneumocephalus?
Surgical evacuation, often with burr holes
What is the most common bacterial isolate in patients with ventilator-associated pneumonia?
S. aureus
In the physiologic compensation for acute anemia what happens to systemic vascular resistance?
Decreases
Hyperventilation will have what effects on:
PaCo2
Hemoglobin-oxygen curve
Oxygen affinity for hemoglobin
Decrease PaCO2
Left shift curve
Oxygen binds more tightly to Hb and less likely to be released and delivered to tissues
Define a grade I and a grade II concussion.
What bearing do they have on athletes returning into games when they occur during a game?
Grade I is confusion without concussion lasting 15 mins or less
Grade II is confusion without concussion lasting more than 15 minutes
Grade I: player can return into game
Grade II: player must exit the game
What is the reason for the development of malignant edema, especially, in pediatric TBI?
Loss of cerebral autoregulation
In the diagnostic criteria for ARDS why is the threshold of arterial pulmonary wedge pressure < 18 mm Hg important for the diagnosis?
Pressures above that suggest left atrial strain and elevated pressures which may suggest PE
