Unit 9: TBI and Stroke Flashcards
What is CPP?
CPP = MAP-ICP
Normal: 60-80 or higher
What is ICP?
Intracranial pressure
Normal: 10-15
What are the effects of oxygen and CO2 on the brain?
CO2 causes dilation, leading to swelling
O2 causes constriction
What is the Monroe-Kellie hypothesis?
States that the total volume within the skull (brain, cerebrospinal fluid, and blood) is constant, and an increase in one component necessitates a decrease in the others to maintain a normal intracranial pressure.
What are interventions to decrease ICP?
Craniotomy
Burr holes
External ventricular drain (usually set at 15)
What are the cranial nerves?
Olfactory Nerve (CN I): Responsible for the sense of smell.
Optic Nerve (CN II): Carries visual information from the eyes to the brain.
Oculomotor Nerve (CN III): Controls eye movements, pupil dilation, and eyelid elevation.
Trochlear Nerve (CN IV): eye movement up and down
Trigeminal Nerve (CN V): Provides sensation to the face, head, and teeth, and controls facial muscles.
Abducens Nerve (CN VI): Controls eye movement to the side.
Facial Nerve (CN VII): Responsible for facial expressions, taste, and tear production.
Vestibulocochlear Nerve (CN VIII): Carries information about balance and hearing.
Glossopharyngeal Nerve (CN IX): Innervates the tongue, pharynx, and salivary glands, and controls taste and swallowing.
Vagus Nerve (CN X): Controls heart rate, digestion, and vocal cords.
Accessory Nerve (CN XI): Controls neck and shoulder muscles.
Hypoglossal Nerve (CN XII): Controls tongue muscles.
What does the Glasgow Coma Scale examine?
eyes, motor, verbal responses
Max is 15, any deviation from 15 is to be reported to provider
What is decorticate and decerebrate posturing?
Decorticate is pulling hands to chest in response to pain (holding onto life)
Decerebrate is rigid, straight arms and hands forming an “e” (giving up life)
What is Cushing’s triad?
Widening pulse pressure
Bradycardia
Hypoxemia
What are early signs of Increased ICP?
Changes in LOC
Slowing of speech/delay in response
Pupil changes
Weakness
Headache
What is a transient ischemic attack? Tx?
Temporary impairment of blood flow to the brain
Resolves within 24 hours without treatment
Stroke symptoms, usually a warning of impending stroke
What are late signs of increased ICP?
Blown pupil
Respiratory/vasomotor changes
Further LOC changes
Cushing’s triad
Posturing
Report any pupil changes to Dr.
What is a ischemic stroke? Tx?
Obstruction that causes infarction of brain tissue
S/S: numbness/weakness in face, arm, or leg; confusion; change in mental status, speech, balance; sudden changes in vision
Tx:
- alteplase is #1
- watch ICP, GCS, LOC, and VS
- Maintain airway, ventilation
- Lower HOB
- Medications
- Hemodynamic monitoring and neurologic assessment
What is a hemorrhagic stroke? Tx?
Bleeds in the brain tissue, ventricles, or subarachnoid space
S/S: similar to ischemic stroke, severe headache, vomiting, early and sudden changes in LOC
Tx:
- CAT scan #1
- Placement of external ventricular drain or craniotomy
- Maintain airway/ventilation
- Manage vasospasm, HTN, seizures, and prevention of further bleeding
- Nimodipine
- Monitor patients VS, ICP, GCS, LOC
What does BE FAST stand for?
Balance
Eyes
Face
Arms
Speech
Time to call for help
What are the time criteria for stroke patients?
Door to telestroke activation 10 min
Stroke to door CT 15 min
Stroke to Door to Alteplase 45 min
Transfer Strok 90 min
What does Alteplase, nimodipine, mannitol, and hypertonic saline do?
Alteplase - cannot give a bleed risk, not in time for adequate effect, recent abdominal surgery or teethe extractions
Nimodipine - for vasospasm
Mannitol - cerebral edema
Hypertonic saline - thinning of mucus to maintain airway
What is a concussion? Tx?
There is no structural damage. Caused by a blow to the head, jarring or shaking, or acceleration/deceleration
S/S: difficulty remembering new information, N/V, sleep problems, emotionally instable, foggy mind
Tx: observation, patient should be aroused regularly and assessed.
What is a contusion? Tx?
A localized bruise on the brain tissue, possible surface hemorrhage
S/S and Tx are dependent upon the amount of damage and associated cerebral edema
What is the difference between a closed brain injury and an open brain injury? Tx?
Closed brain injury is usually blunt trauma or acceleration/deceleration injury
Open brain injury is when an object penetratess the brain or the trauma is so severe that the scalp and skull are opened.
What is the basics of post-concussion syndrome?
Occurs when symptoms from a concussion persist beyond the expected recovery period, often lasting for weeks, months, or even years, and can include persistent headaches, dizziness, fatigue, and cognitive difficulties
When is interventions needed for ICP? Ways to monitor?
> 20 ICP level
Bolt
Transducer-tipped catheter
External ventricular drain
(ventriculostomy) - records ICP and allows CSF to drain
What is the most common casue for TBI?
Falls/Trauma
TBI is the common cause of death from trauma
What are manifestations of a TBI?
Altered LOC
Abnormal pupils
Neurologic changes (sensation, movement, reflexes)
Changes in VS
Headache
Seizures
Watch for Halo - indication of CSF in blood
Battle’s sign - bruising behind the ear
What is epidural hematoma?
Blood between skull and dura; from an ARTERY
Decrease LOC to normal to decreased
Respiratory arrest can happen in minutes, watch for it.
An emergency situation!
Tx: remove clot, burr, or craniotomy
What is subdural hematoma?
Collection of blood between the dura and the brain
Acute: within 48hrs
Subacute: 48hrs to 2 weeks
Chronic: 2+ weeks, causative injury may be minor and forgotten, s/s may fluctuate, tx is evacuation of clot
What is intracerebral hemorrhage?
Hemorrhage occurs into the substance of the brain
Tx: supportive care, control of ICP, fluids/electrolytes, antihypertensive medications, possible craniotomy to remove clot
What is the care of the patient with a head injury?
**Assume SCI until it is ruled out
Use Mannitol - cerebral edema
Use Nimodipine - cerebral vasopsasm
Maintain perfusion
Maintain O2
Manage fluid and electrolyte balance
Therapeutic hypothermia
Hyperbaric oxygen therpay
