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Emrg 1230 > Week 11- Neurological Disorders > Flashcards

Week 11- Neurological Disorders Flashcards

1
Q

Initial response to bruising

A
  • Vasodilation and increased blood flow to the area of injury
  • Pressure surrounding the injury site
  • Increased intracerebral pressure - decreased blood flow
  • Edema develops over a period of hours
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2
Q

Normal Functioning Brain

A
  • Adjusts blood flow to your metabolic needs
  • Based on O2 & CO2 levels in the blood and Cerebrospinal fluid (chemoreceptors
  • Decreased CO2 levels will cause- Hypervenilation- cerebral vasoconstriction and cerebral ischemia (hypoxia)
  • Increased CO2 levels will cause- Hyperventilation, vasodilation and edema (hypoxia)
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3
Q

Intracranial Pressure

A
  • The pressure inside of the cranium as a result of: brain tissues, blood, CSF
  • Normal pressure 5-15mm hg
  • 15 mm hg upper limit of normal
  • Volume changes of any one are at the expenses of the others
  • Blood supply can’t be compromised (need oxygen and glucose to survive)
  • No room for the tissues to expand
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4
Q

What are the different brain pressure?

A
  • ICP- Intracranial pressure (<15 m hg)
  • CPP- Cerebral Perfusion Pressure- pressure needed to maintain blood flow to the brain (70-80mm hg), No less than 60 mm hg (doubles the patients chances of death)
  • MAP-Mean Arterial Pressure (70-100mm hg).<60 can be deadly to main organs
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5
Q

Cerebral Perfusion Pressure

A
  • CPP= MAP - ICP
  • ICP <15 mm hg normally
  • With brain swelling or bleeding inside the skull- Increased ICP- Decreased CPP- Cerebral vasodilation, increased ICP-
  • When ICP= MAP, BLOOD FLOW STOPS
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6
Q

ICP- Early Signs

A
  • Shifts CSF to the spinal cavity to compensate
  • Decreasing cerebral blood flow
  • Effective for a short time until you become hypoxic
  • Hypoxia triggers arterial vasodilation in the brain in an attempt to improve blood supply- adds fluid volume
  • Bc of these responses, ICP is significantly elevated before apparent
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7
Q

Other Early Signs and Symptoms of ICP

A
  • Severe headache- stretching of the dural layer and walls of the large blood vessels
  • Vomiting- projectile without food intake association- pressure stimulating the emetic centre of the medulla
  • Papilledema- swelling of the optic discs and ICP
  • Seizures
  • Signs increase in severity until ICP is controlled
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8
Q

Vital Signs of ICP

A
  • If ICP continues to build up, there is a sequence of events that occurs in an attempt to supply oxygen to the brain
  • Cerebral ischemia- cushing’s reflex in the vasomotor centre of the brain (decreasing pulse, increasing systolic pressure w widening pulse pressure, irregular respirations)
  • Attempt to increase the blood supply to the brain
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9
Q

Systemic Vasoconstriction

A
  • Increases the BP and forces more blood into the brain to relive the ischemia
  • Baroreceptors in the carotid arteries to the increase in BP by slowing the HR
  • Chemoreceptors respond to low CO2 levels from accelerated systemic circulation by slow the RR
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10
Q

Then…

A
  • Improved cerebral circulation relieves the ischemia and the vasoconstriction relaxes…
  • Rising ICP causes ischemia to recur and the cycle is repeated
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11
Q

Results of Increased ICP

A
  • The brain responds to ischemia by one mechanism… but the feedback control for increased BP uses other mechanisms to protect the rest of the body
  • The 2 mechanisms are in conflict of interest
  • Eventually severe ischemia and neuronal death prevent any circulatory control and BP drops
  • Respiratory Centre control is destroyed resulting in abnormal resp patterns
  • Death is inevitable of the pressure is not released
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12
Q

Cushing’s Response

A
  • HTN, Bradycardia, Irregular Respirations
  • As the pressure arises- the body’s reflex mechanism cant keep up- Uncompensated
  • Pressure increase to a critical point where there is no perfusion- deterioration and death occurs
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13
Q

What is Cerebral Herniation Syndrome?

A
  • Brain swelling eventually forces tissues downward through the foramen magnum
  • Obstruction of blood flow
  • Pressure on the brain stem- vital centres that causes death
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14
Q

What are the S&S of Cerebral Herniation Syndrome?

A
  • Decreased LOC
  • Coma
  • Dilation of pupil on same side
  • Paralysis on the opposite side of the body
  • Decerebrate posturing (extension)
  • Increased BP
  • Bradycardia
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15
Q

What is the treatment for Cerebral Herniation Syndrome?

A
  • Hyperventilation to reduce swelling 1:3 secs
  • Hyperventilation causes vasoconstriction, which causes blood to go to the brain, reducing blood flow
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16
Q

Scalp Wounds

A
  • Vascular and bleed well
  • Vasospasm is inhibited- prolonged and significant bleeding
  • Without skull injuries- direct pressure is indicated
17
Q

What are the different Skull Injuries?

A
  • Linear nondisplaced
  • Depressed
  • Compound
  • Suspected skull injuries with large contusions
  • Leave protruding objects in place
  • Transport immediately
18
Q

What are the different brain injuries?

A
  • Concussion
  • Cerebral contusion
  • Diffuse axonal injury
  • Anoxic brain injuries
  • Closed head injuries- countercoup injuries
19
Q

Concussion

A
  • History of trauma- Mild blows to the head causing sudden excessive movement of the brain- LOC
  • No structural damage to the brain- reversible interference of brain function
20
Q

Brief disruption of neural function:

A
  • Period of unconscious or confusion
  • Return to normal
  • Short term memory loss (amnesia)
21
Q

Concussion Sign and Symptoms

A
  • Headache, dizziness, tinnitus (ringing sound), nausea
22
Q

What is a cerebral contusion?

A
  • Bruised brain tissue with ruptured small blood vessels (usually from a blow to the head)
  • Brain swelling may be rapid and severe
23
Q

What are the sign and symptoms of cerebral contusion?

A

(depends on force):
- prolonged unconscious
- Altered LOC
- Personality changes
- Profound confusion
- Persistent amnesia
- Abnormal behaviour
- Focal neurological signs

24
Q

What are Basilar Fractures?

A
  • Occur at the base of the skull
  • Often accompanied by leaking CSF through the nose and ears
  • Often occur when the forehead hits a car windshield with considerable force
  • Diagnosed with dark discolouration around the eyes and behind the ears
25
Q

What is depressed skull fracture

A
  • Displacement of a piece of bone below the level of the skull (this compresses brain tissue)
  • Blood supply to that area is impaired
  • ICP often high
26
Q

What is a Diffuse Axonal Injury?

A
  • Most common head injury, Severe blunt head trauma
  • Diffuse injury to the brain, stretching, shearing, tearing of nerve fibres, from brain moving back and forth
  • Generalized edema
  • Subarachnoid bleeding with irritation to the surrounding tissues
27
Q

Signs and Symptoms of Diffuse Axonal Injury?

A
  • Seizure activity, Coma, Vomiting
  • Herniation syndrome possible
  • Often results in permanent vegetative state
28
Q

What is anoxic brain injur?

A
  • Lack of oxygen to the cells (cardiac arrest, airway obstruction, drowning)
  • Spasm of the cerebral arteries- perfusion is affected to the cortex
  • After 4-6 mins to anoxia- irreversible
  • Restoring blood pressure and oxygen will not restore perfusion
29
Q

What are closed head injuries?

A
  • Occurs when the skull is not fractured in the injury
  • Brain tissue is injured from the force exerted against the skull
  • Blood vessels may rupture due to force
  • Countercoup injury
30
Q

What is countercoup injury?

A
  • Rebound of the skull causes the brain to impact the opposite side of the skull
31
Q

What is a spinal cord injury?

A
  • Results from fracture of dislocation of vertebrae which stretches, compresses or tears the spinal cord
  • May be temporary or permanent
  • Nerves in the spinal cord don’t regenerate
  • Complete transection results in irreversible loss of function below the level of injury, partial may allow for some recovery
  • Bruising is reversible- temporarily impairs nerve function
32
Q

What is the result of a spinal cord injury?

A
  • Any compression of the cord must be relieved quickly to maintain blood supply
  • As with any trauma, bleeding and inflammation develop creating additional pressure and interferes blood flow
  • Initially injury may appear widespread- as edema subsides, may see partial recovery of function
33
Q

How many stages are there to a spinal cord injury?

A
  • 2 stages: 1) early stage 2) recovery
34
Q

S&S- Early Stage

A
  • During initial period of spinal shock, all neurologic activity ceases at/ below the level of injury
  • No reflexes will be present including muscle, sensory and autonomic (bowels, bladder)
  • May persists for days or weeks
  • At cervical level, this includes loss of control of BP, diaphoresis, body temp, and bowel and bladder emptying
35
Q

S&S- Recovery

A
  • Recovery is indicated by gradual return of reflex activity
  • Check dermatome response to assess
  • May have loss of pain/ sensation
  • Permanent- quadriplegia/ paraplegia
36
Q

Intracranial Hemorrhage

A

Types are classified by their location:
- Extradural or Epidural Hematoma- between the skull and the Dura
- Subdural Hematoma- between the Dura and the Arachnoid
- SubArachnoid- between Arachnoid and Pia
- Intracerebral Hematoma- directly into the brain tissues

37
Q

Epidural Hematoma

A
  • Bleeding between the Dura and the skull
  • Usually from a tear in the middle meningeal artery in the temporal regions
  • Results from linear fracture- arterial bleed- quick onset and deadly outcome

Emrg 1230 (24 decks)

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