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ACP - Columbia > Week 34 Neuro Trauma Peds > Flashcards

Week 34 Neuro Trauma Peds Flashcards

1
Q

What is a the target BP in a patient with ICP?

A

Above 110-120

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2
Q

What is CPP?

A

MAP-ICP

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3
Q

What is herniation?

A

Brain being pressed down through foramen magnum due increased pressures in brain. (swelling)

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4
Q

Do you hyperventilate a ICP patient? T/F

A

FALSE YOU DUMMY

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5
Q

What is important factor to note regarding perfusion to the brain in regard to ICP

A

Increased ICP results in decreased blood availability to the brain

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6
Q

What are extra axial TBI’s?

A

Epidural hematoma, subdural hematoma, subarachnoid hemorrhage

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7
Q

What does extra axial mean?

A

Swelling is inside the skull and not involving brain parenchyma

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8
Q

What does intra axial mean?

A

involves the brain parenchyma

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9
Q

What is an example of a intra axial TBI

A

DIA

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10
Q

What is a primary head injury?

A

Impact

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11
Q

What is a secondary head injury?

A

Swelling (can persist for hours or days)

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12
Q

What is an epidural hematoma?

A

Blood collection between dura mater and inner aspect of periosteum

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13
Q

How does an EDH present? Symptoms?

A

LOC with a period of lucidness and regain of consciousness followed by a rapid deterioration, increased ICP. Symptoms of H/A, N/V, Focal neuro deficits ie weak, numb, vision, hearing.

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14
Q

How does an SDH present?

A

blood collection between the dura mater and arachnoid mater, bleeding source is commonly the bridging veins that connect cerebral venous sinuses (vulnerable to massive accel and decel)

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15
Q

What is important to remember with regards to head injuries in the elderly or chronic ETOH?

A

They have stretched out bridging veins, minor head trauma can cause acute SDH

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16
Q

Why are SDH considered to be “dangerous”

A

It is a venous bleed therefore it is slow and build it over time and not be caught until it is to late sometimes

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17
Q

Symptoms of SDH?

A

History of trauma, increased ICP, bad h/a, n/v, unsteady gait, confusion, cognitive problems, visual problems, slurred speech, dizzy, seizures, hemiparesis.

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18
Q

What is the brain parenchyma?

A

Functional tissues of the brain.

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19
Q

What is a SAH?

A

Subarachnoid hemorrhage, bleeding between the arachnoid mater and pia mater.

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20
Q

Common causes of SAH?

A

Head trauma, or spontaneous aneurysm rupture ie berry aneursym (AVM, genetic)

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21
Q

Symptoms of SAH?

A

Thunderclap H/A, rapid progression, nuchal rigidity, seizures and increasing signs of ICP (N/V, vision disturb, confusion)

22
Q

How does a diffuse axonal injury occur?

A

result from shearing forces that stretch and tear white mater axons in the brain disrupting communication of nerves leading to nerve cells dying and brain swelling due to this

23
Q

What is central herniation?

A

downward displacement of brain stem

24
Q

Signs of increased ICP

A

cushings triad, focal neuro signs

25
Q

What is cushings triad?

A

HTN, bradycardia, IRR RR

26
Q

3 layers of the meninges?

A

dura mater, arachnoid mater, pia mater

27
Q

Causes of spinal cord injury

A

Trauma, infection, ischemia, tumors

28
Q

What is the cervical spine responsible for?

A

sensory to neck, shoulder. and upper arms

29
Q

What is the thoracic spine responsible for?

A

motor movement and sensory to thorax and abdomen

30
Q

What is the lumbar spine responsible for?

A

low back, hips, legs, motor and sensory

31
Q

sacral spine responsible for?

A

lowers legs, pelvis motor and sensory

32
Q

What is important to note about a SCI?

A

injury to effected region impacts anything below it as brain signals can not reach that part of the body

33
Q

What is the cause of SCI?

A

direct trauma or compression from fx vertebrae or masses

34
Q

What could a leak of CSF indicate?

A

Head injury, tear in dura allowing csf to leak out

35
Q

What can a high cervical injury manifest as?

A

hypotension, bradycardia, loss of sympathetic tone (neurogenic shock)

36
Q

What is neurogenic shock? How does it manifest?

A

results from upper cervical injuries affecting cervical ganglia leading to loss of sympathetic tone. loss of sympathetic tone results in a shock state manifesting as hypotension and bradycardia

37
Q

How does EDH manifest? History and Physical?

A

arterial: bleeding from branch of middle meningeal artery, anterior meningeal artery or dural arteriovenous fistula. venous: lac of dural venous sinus. LOC following trauma followed by a lucid interval then a rapid neuro deterioration. Physical: increased ICP, pupil changes, cushings vomiting, drowsy, confusion, seizures, weakness.

38
Q

Patho of SDH? Hx? Physical?

A

accel-deecel causing trauma and rupture of bridging veins within the meninges causing them to bleed into the subdural space. Hx: trauma, or SIDS, (retinal bleeding a sign of SIDS), Physical: H/A. LOC, neuro deficits, posturing, cheyne stokes

39
Q

Patho of SAH, Hx? Physical?

A

ruptured cerebral aneurysm or trauma, (AVM). Symptoms: thunderclap headache, lateral h/a, pupil asymmetry, brief loc, n/v, seizure. increased ICP, nuchal rigidity, photophobia, focal deficits.

40
Q

How do ruptures occur?

A

hemodynamic stress to vessel wall due to HTN promotes formation and rupture of aneurysms.

41
Q

What is downsyndrome?

A

A genetic condition where the person has 47 chromosomes and not the normal 46

42
Q

What is important to note about down syndrome?

A

It effects almost every organ in the body

43
Q

What is hydrocephalus?

A

symptomatic accumulation of CSF inside the cerebral ventricles

44
Q

What are the ventricles?

A

Cavities of the brain that produce CSF

45
Q

3 causes of hydrocephalus>?

A

Excess production of CSF, impaired reabsorption of sf into blood stream, blockage that causes accumulation.

46
Q

4 types of hydrocephalus?

A

communicating, obstructive, hypersecretory, normal pressure

47
Q

what is communicating hydrocephalus?

A

impaired absorption of csf due to past hemorrhagic or post inflammatory changes, SAH

48
Q

What is obstructive hydrocephalus?

A

block in csf pathways

49
Q

What is hypersecretory hydrocephalus?

A

overproduction of csf due to tumours

50
Q

what is normal pressure hydro

A

not well understood, no icp, impaired csf dynamics

51
Q

What is the monroe kelly doctrine?

A

total volume of brain, blood, csf within skull is constant. an increase in one compartment must accompany a decrease in volume in another otherwise pressure in head will increase

52
Q

What is spina bifida?

A

neuro condition from failure of neural tube closure of varying degrees during fetal development can be either closed or open

ACP - Columbia (19 decks)

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