Unit 7 - Neuro Flashcards
Do patients with ALS have increased or decreased extra junctional receptors ?
Increased
Should succ be given to patients with extra junctional receptors? Why or why not?
No - increased risk for lethal hyperkalemia
What diseases increase extra junctional receptors?
Burns
Crush injuries
Spinal cord injuries
Prolonged immobility
Is a spinal anesthetic recommended in patients with increased extra junctional receptors?
No
Epidural MAY be okay if it outweighs the risk of intubating the patient
Epidural doses use less local so a decreased risk of complications
Do patients with ALS need less or more Non depolarizing NMB?
Less
If too high of a dose, prolonged paralysis may occur
Brain anatomy
Where is the best location to monitor ICP?
A ventriculostomy catheter - gold standard
Also can be measured intraparenchymal and subarachnoid
What is autonomic hyperreflexia?
Intense sympathetic response below the level of the spinal cord injury
BP and HR readings for autonomic hyperreflexia?
HTN
Bradycardia
Vasoconstriction vs vasodilation in autonomic hyperreflexia?
Severe vasoconstriction below the level of the injury and severe vasodilation above the level of injury
Will flushing be seen in autonomic hyperreflexia? If so, where?
Yes - above the level of the injury. Seen in the face due to severe vasodilation above the level of the injury
What will happen to the LV in autonomic hyperreflexia?
Left ventricular failure due to intense vasoconstriction
Treatment for autonomic hyperreflexia?
- Stop the triggering event
- Direct vasodilators
- Avoid beta blockers
What level does autonomic hyperreflexia usually develop?
T5-T7
Does not usually develop with injuries below because of the greater splanchnic ganglia can buffer any response
Temperature target for cerebral protection?
32-24 C for 12-24 hours
Glucose target for cerebral protection?
90-180
What is the first line treatment for seizures?
IV benzodiazepines
NOT the recovery position
What is the second line treatment for seizures? How does it work?
Phenytoin which prolongs NA Channels
When is a vasospasm most likely to develop after a subarachnoid hemorrhage?
4-9 days
When is the best time to repair a cerebral aneurysm?
First 24-48 hours
What is the most productive treatment for a cerebral vasospasm?
Triple “H”
Hypervolemia
Hypertension
Hemodilution
When should anticholinesterase be administered when reversing a patient?
Once 4/4 twitches have been achieved
Which nerves transmit burning pain?
C fibers
Which nerves transmit intense, sharp, tingling sensation?
A delta
