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Emergency Medicine > Unit 3 Lecture 6 > Flashcards

Unit 3 Lecture 6 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

normal ICP in adults

A
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2
Q

what are the 3 intracranial components

A

brain parenchyma, CSF, blood

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3
Q

what is a “critical parameter for brain function and survival?”

A

cerebral blood flow

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4
Q

complications a/w elevated ICP

A

brainstem compression (herniation); reduction in CBF

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5
Q

most common herniation

A

uncal herniation

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6
Q

cushing’s triad

A

bradycardia, respiratory depression, HTN (correlates with brainstem compression)

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7
Q

decorticate

A

hands to the body core

-lesion in the corticospnial tract from cortex to upper midbrain

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8
Q

decerebrate

A

extension of arms

-damage to corticospinal trac at level os the pons or upper medulla

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9
Q

what causes a blown pupil

A

CN III compression

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10
Q

CN a/w direct and indirect pupillary repsonse

A

CN II and CN III

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11
Q

CN a/w EOM’s

A

CN III, IV, VI

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12
Q

CN s/w vestibulo-ocular reflexes

A

CN VIII, III, VI

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13
Q

CN a/w mastication

A

CN V

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14
Q

CN a/w corneal reflex

A

CN V (sensory) and VII

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15
Q

CN a/w cough/gag reflex

A

CN IX and X

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16
Q

management of ICH/ICP

A

refer to neurosurgery (decompressive craniectomy)

  • maintain O2 sat >90%
  • BP; cerebral perfusion pressure >60mmHg
  • ICP
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17
Q

leading cause of TBI

A

falls (esp 65yo+)

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18
Q

linear skull fx

A

single fracture that most often extends throught the entire thickness of the calvarium

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19
Q

depressed skull fx

A

traume and drives a segment of the skull below the level of the adjacent skull
-often injury to brain parenchyma

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20
Q

basilar skull fx

A

at least 1/5 bones that comprise the base of the skull

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21
Q

signs of basilar skill fx

A

hemotypmanum, raccoon eyes, battle sign, CSF otorrhea or rhinorrhea

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22
Q

most commonly affected bone in basilar skull fx

A

temporal bone

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23
Q

basilar skull fx at risk for which type of hematoma

A

epidural hematoma

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24
Q

imaging of choice for suspect skull fracture

A

noncontrast CT

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25
Q

what is diffuse axonal injury (DAI)

A

shearing of white matter tracts

-a/w posttraumatic coma

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26
Q

CT of DAI

A

blurring of gray to white matter margin, cerebral hemorrhages, or cerebral edema

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27
Q

epidural hematoma

A

a/w skull fracture

  • middle meningeal artery
  • lucid interval
  • lens shaped CT
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28
Q

subdural hematoma

A

tears of bridging veins

  • a/w brain atrophy (elderly and alcholics)
  • crescent shape CT
29
Q

most common type of intracranial hematoma (hemorrhagic or ischemic)

A

ischemic

30
Q

a/w “worst HA of my life”

A

subarachnoid hemorrhage

31
Q

dx of SAH

A

CT without contrast!

-if normal and no papilledema->LP (bilirubin peak)

32
Q

gold standard for detecting intracranial aneurysms

A

digital subtraction angiography

33
Q

most common cause of intracerebral hemorrhage

A

hypertension

34
Q

ICH management

A

admit to ICU and emergent neurosurg. consult, same as ischemic CVA (BP control, manage elevated ICP, avoid hyperglycemia keep glucose between 140-180, seizure prophylaxis and treatment)

35
Q

pts with intraventricular hemorrhage are at risk for what?

A

hydrocephalus

36
Q

dx of IVH with neuro deterioration

A

CT

37
Q

tx of IVH

A

ventriculostomy and external ventricular drainage

38
Q

acute ischemic CVA management

A

eval for thrombolytic therapy, ASA if not tPA candidate

39
Q

management if not candidate for IV thombolysis

A

allow for permissive HTN (no intervention unless SBP >220 or DBP >120

40
Q

management if candidate for IV thromblysis

A

target BP

41
Q

thombolytics inclusion criteria

A

clinical dx of ischemic stroke, onset of sxs

42
Q

Head CT scan exclusion criteria (slide 64 FYI but this was highlighted)

A

multilobar infarction with hypodensity involving >33% of the cerebral hemisphere

43
Q

initial tx of seizure

A

immediate ABC’s and IV anticonvulsants (although not indicated during an uncomplicated seizure)

44
Q

management of eclamptic pt with seizure

A

emergent OB constult, admin magnesium sulfate

45
Q

what is a jefferson fx

A

most common fracture of C1 (atlas)

-caused by axial compression

46
Q

cause of C2 (axis) fx

A

forceful flexion or extension

-type I is stable, types II and III unstable

47
Q

C2 fracture involving both pedicles

A

hangmans fx

-caused by hyperextension with compression

48
Q

most common level of disc herniation in the C spine

A

C6-7

49
Q

clinical presentation of cauda equina syndrome

A

urinary retention, radic., BLE weakness, saddle anesthesia, decreased anal sphincter tone

50
Q

following what type of injury does neurogenic shock usually occur?

A

after cervical spine injury

51
Q

signs/sxs of complete spinal cord injury

A

early->flaaccid paralysis, absent reflexes, priapism

within 1-3days->hyperactive reflexes, +babinski, spasticity

52
Q

central cord syndrome

A
  • hyperextension injury
  • UE motor impairment
  • sensory loss or bladder dysfunction
53
Q

brown-sequard syndrom

A
  • penetration trauma
  • ips. loss of motor function, proprioception, and vibration sensation
  • contr. loss of pain and temp. sensation
54
Q

management of CSI

A
  • airway!
  • immobilize spine
  • imaging
  • neuro/spine consult
55
Q

ventilation impairment based on location of SCI

A
  • complete injury above C3: near total ventilatory muscle paralysis
  • injury at C3-5: variable impairment of diaphragmatic strength and accessory muscles of ventilation
  • C6 or above (*per notes, but I think it should be below): may compromise resp. function
56
Q

Guillian-Barre Syndrome

A
  • ascending paralysis that is symmetric
  • mild URI or gastroenteritis precedes 1-3 weeks
  • progresses over a period of 2 weeks
57
Q

most common demyelination neuropathy

A

GBS

58
Q

dx of GBS

A

LP-elevated CSF protein without pleocytosis

59
Q

tx of GBS

A

admit, neuro consult, high dose IVIG and plasmapheresis

60
Q

when is imaging indicated if bell’s palsy is in the differential?

A

Bi involvement/atypical; forehead sparing; hx of trauma

61
Q

tx of bell’s palsy

A

steroids and antiviral

62
Q

which type of meningitis is a neurologic emergency

A

bacterial

63
Q

sxs of meningitis

A

HA, stiff neck, and fever, rash

64
Q

dx of meningitis

A

LP with CSF analylsis

65
Q

tx of meningitis

A

early IV dexamethasone and abx

66
Q

encephalitis

A
  • viral infection
  • culture of blood AND CSF
  • empiric antiviral tx
67
Q

most common sx of brain abscess

A

HA

68
Q

when is LP contraindicated when brain abscess is present

A

focal sx or signs

69
Q

definitive dx of brain abscess

A

brain bx

Emergency Medicine (6 decks)

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