week 6 Flashcards
scalp laceration complications
Scalp is highly vascularized
- bleeding
- infection
skull fracture s/s
- raccoon eyes and/ears
- Rhinorrhea or otorrhea
- test for CSF - Halo sign
how do you test drainage for CSF
if it has glucose then it is CSF
what is the halo sign
put a drop of drainage onto a gauze if a red spot with a halo around it appears then it indicates CSF drainage
when would you suspect concussion
if the patient passed out
what is diffuse axonal injury
injury inside the brain leading to either decortication or decerebration
decortication vs decerebration. What are they and which is worse
Decort=internal flexion
Decere-extention away from the body
Decere is worse
what is a contusion and what is the most common cause
brusing in brain tissue
-Coup-countercoup (whiplash)
what is a laceration of the brain
actual tearing of the brain tissue
complications of head injuries
1.Hematomas
how do you identify epidural hematomas
initial loss of consciousness followed by brief lucid period then degradation as ICP increases
how do you identify subdural hematoma
same as epi expect its slower
what is an intracerebral hematoma
bleeding within the brain
what is the gold standard diagnostic for head injuries
CT scan but MRI is better
what does a PET scan show
blood flow in the brain
what is a craniotomy
replacing part of the skull with metal or leaving it open. If you leave it open it is called a craniectomy
What is a Burr hole
drilling a hole in the skull to put a catheter iin
what makes up ICP
CSF is 10%
blood is 12%
the rest is brain tissue
what factors influence ICP
- arterial and venous pressure
- Intraabdominal and intrathoracic pressure
- temperature
- CO2 levels (vasodilation -> more blood to the brain)
what must the transducer of the ICP monitor be leveled with
the tragus of the ear
what happens when ICP goes up
- decreased cerebral perfusion
2. brain stem hernitation
cerebral blood flow definition
the amount of blood passing through 100 g of brain tissue in 1 min. normal is about 50 mL
cerebral perfusion pressure (CPP)
the pressure needed to ensure adequate perfusion to the brain. similar to MAP
normal is 60-100
how is CPP calculated
MAP-ICP
what happens if CPP drops below 50
its like a MI of the brain you got 6 minutes until perm brain damage occurs
compensentory mechanisms to increase cerebral blood flow
- increase CO2
- decrease O2 (vasodilation)
- increase H+ concentration, acidosis -> vasodilation
hypothermic measures
cool body to 32-35 but in practice they go down to 28.
what do you need to monitor during hypothermic measures
bradycardia
Cerebral edema
- monitor LOC
- give mannitol
- cushing triad
- conjugate gaze palsy
- Uneven and sluggish pupils
- Decerebrate or Decorticate
- Headache (major)
- Projectile vomiting (major)
what is vasogenic cerebral edema
it is cerebral edema caused by the breakdown of the blood brain barrier (BBB)
what is the cushing triad
- increase BP
- Irregular breathing
- decrease HR
what is conjugate gaze palsy
inability to move eyes in the same direction. Either horiztonally or vertically
how do you diagnose cerebral edema
CT scan
what does EEG do
monitors electrical activity of the brain
what is EEG mainly used for
to detect real seizures
ventriculostomy
- CSF drains into a drainage system
2. level with tragus of ear or canthus of eye
Hypertonic solutions (mannitol) interventions
give slowly
what are barbiturates used for
control seizures
what diet do you put patients with cerebral edema
increased glucose
how do you assess for pain in unconscious patients
nail bed pinch
gold standard stroke diagnostic
CT
TPA
- give within 4.5 hours
2. minimal oozing is expected when given peripherally but gum and nose bleeding is not
TPA contraindications
- active bleed
- recent major surgery
- recent stroke b/c they may bleed
carotid endartrectomy
open carotids and take out plaques
post stroke consideration
- bowels will slow down which may lead to impaction
- patients may be incontinent -> skin breakdown
- bed bound -> DVT -give aspirin
- during stroke BP shoots up to compensate for low CPP. if they have an aneurysm -> hemorrhagic stroke
what is the acceptable BP during stroke
around 160 before you give the TPA
right sided stroke cardinal sign
loss of spatial perception. They may not even know who they are
can stroke patients eat food?
they must be NPO until they pass their swallow evaluation
-food must be eaten on unaffected side while patient sits up
how is aneurysm treated
- Clipping
2. GDC coil- stuffing the bludge therefore inhibiting blood flow into it therefore it wont rupture
Homonymous hemianopsia
total loss of a certain visual field in both eyes
Right sided stroke
- learn better verbally
- impulsive
- lack of cordination
Left sided stroke
- move slower
- fearful and anxious
- respond well to nonverbal
Spinal cord injury etiology
cord compression by bone displacement. Leading to sciatic pain
Spinal shock s/s
- decreased reflexes
- loss of sensation
- Flaccid paralysis below level of injury
Neurogenic shock s/s
- loss of vasomotor tone -> venous pooling
- type of distributive shock
- decrease BP and HR
how long do skeletal or muscular injuries take to heal
usually 3 weeks if it doesnt then we need to do a CT or MRI
how do we know that we have complete cord involvement
both sensory and motor damage
ASIA scale
monitors spinal cord injury progression
what happens if you have an injury above c4
immediate intubation is required b/c of total loss of respiratory function
what happens if the injury is below C4
diagphramatic breathing (shallow breathing) will retain secretion and CO2 -> hypoventilation
Thoracic spine injury
- Neurogenic shock
- Abdominal paralysis -> ileus, urinary retention
- must do NG tube decompression
lumbar spine injury
1.incontinence
Poikilothermism
- loss of thermal regulation
- decrease in ability to sweat and shiver
- many of these patients develop hyperactive reflexes but this does not indicate healing
autonomic dysreflexia
increase BP due to bowel impaction or urinary retention.
lumbar puncture contraindications
- high ICP can lead to brain herniation
2. anticoagulants can result in bleeding the compresses the spinal cord
lumbar puncture instructions
have client void prior to procedure
- cannonball position while on side to stretch the spinal canal. they can also stretch over an overbed table if they prefer to sit
- remain lying for several hours post procedure to ensure that the site clots and also decrease incidence of post lumbar headaches caused by CSF leak
