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INP3 - SALLY > Week 6 - Neuro > Flashcards

Week 6 - Neuro Flashcards

1
Q

causes of ACS

- 2 types

A

cerebral causes of ACS

  • head injury
  • oedema
  • haemorrhage
  • infection
  • meningitis
  • seizure
  • stroke
  • brain tumor

non cerebral causes of ACS:

  • acidosis
  • hypoxia
  • hypotension
  • hypoglycaemia
  • hyperglcaemia
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2
Q

management of patient with ACS

DRSABCDE

A

Response - @
airway - @
Breathing - warm pink pt signs of Co2 retention
circulation - MAP

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3
Q

ACS pt investigations

A
  • head CT
  • pathology
  • lumbar puncture
  • insertion of ICP monitor
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4
Q

ICP normal value

A

ICP <15mmhg

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5
Q

signs of increased ICP

A

EARLY:

  • ACS (restless, agitated, confused, drowsy)
  • headache
  • increased UO >300ml/hr
  • nausea and vomiting
  • pupil changes
  • seizures

Late:

  • unresponsive
  • Cushings Reflex
  • hypertensive
  • widening pulse pressure
  • bradycardia
  • cheynes stokes respirations (irregular and deep) sign of brainstem compression
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6
Q

Management of raised ICP

A

AIMs:

  • maintains/ optimize cerebral perfusion
  • decrease ICP to under 20mmhg

INTERVENTIONS:

  • osmotic diuretic
  • drainage of CSF
  • surgical decompression (craniectomy)
  • if untreated increased ICP will result in herniation of brain tissue and deathn
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7
Q

primary brain injury

A

damage occurs at the time of impact

  • can be focal of diffuse
  • severity depends on extent of intial head injury
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8
Q

diffuse axonal injury

A

commonly associated with rotational acceleration/ deceleration movement > producing tension, stretching and shearing of brain tissue

  • produces prolonged coma
  • 33% survive with severe disability of remain in a persistent coma state
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9
Q

secondary brain injury

A 
- occurs post initial insult 
may be due to:
- hypoxia
- hypotension
- increased ICP
- hypo/ hyperglycaemia 
- infection
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10
Q

cerebral oedema

A

swelling of the brain itself with or without associated bleeding
- leads to increased ICP

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11
Q

concussion

A

is a violent jarring or shaking that results in a disturbance to brain function

  • due to blunt trauma or acceleration/ deceleration
  • no gross structural damage
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12
Q

concussion - signs and symptoms

A
  • ACS (+/-) LOC
  • dizziness, drowsiness, confusion
  • vomiting
  • transient visual disturbances
  • changes to vital signs are rare but possible
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13
Q

Base of skull fracture

A

can be associated with underlying cranial nerve and vascular injuries

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14
Q

Base of skull fracture - clinical manifestations

A
  • raccoon eyes
  • agitation
  • battle sign (brusing behing the ear)
  • CSF leak
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15
Q

Cerebral Contusion

A
  • brusing in brain in area of cortex or deeper
  • commonly in frontal temporal or occipital lobes
  • causes greater neurological deficits that concussion due to structural changes from brusing
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16
Q

Cerebral Contusion - signs and symptoms

A
  • seizures
  • personality changes
  • aphasia
  • LOC or Coma
17
Q

Intercranial bleeding

- 4 types?

A
  • intracerebral hemorrhage
  • epidural hemotoma
  • subarchnoid hemorrhage
  • subdural Hamotoma
18
Q

define each type of intercranial bleed

A

intracerebral hemorrhage:
- bleeding inside the brain

epidural hemotoma:
- bleeding between the dura matter and the skull

subarchnoid hemorrhage:
- bleeding in the subarchnoid space

subdural Hamotoma:
- bleeding between the archonoid matter and the dura matter

19
Q

management of pt with intracranial bleed

A

pharmacological:

  • hypertonic saline
  • diuretic (frusemide)
  • antibiotics
  • sedatives

surgery:

  • surgical evacuation
  • clips

other:

  • nutrition (will lose a lot of weight)
  • fever treated aggressively (temp regulation)
20
Q

Stroke - define

A

an acute neurovascular injury secondary to cerebral vascular disease

ischemic (80%)
heamorrhagic (20%)

FAST!!

21
Q

stroke - risk factors

A
  • hypertension
  • increased age >55yrs
  • family history
  • smoking
  • AF
  • recent AMI
22
Q

stroke - management

A

TIME = Brain
- once brain tissue deprived of oxygen brain will get neuronal death > brain will continue to deteriorate if left untreated

*rapid assessment and identification of pts who may be eligible for thrombolysis

23
Q

stroke - interventions

A

Airway:
- intubate if GCS T wave inversion common in 75% of pts with acute stroke)

Disability:

  • GCS (pupil size every hr)
  • BGL (2 - 4hrly)
  • nil oral until review (possible impaired swallow)
  • CT
24
Q

Thrombolysis inclusion criteria

A
  • less than 3hrs since stroke symptoms
  • BGL 2.7 - 22mmol/L
  • evidence of ishcaemic stoke on CT scan
25
Q

Thrombolysis exclusion criteria

A
  • onset of symptoms >3hrs
  • BGL 22mmol/L
  • previous stroke or serious head trauma within 3 months
  • major surgery in last 14 days
  • pregnant

check haemorhagic risk

  • INR >1.7 on warfarin
  • IV heparin within last 48hrs
  • systolic BP >185
  • diastolic >110

INP3 - SALLY (9 decks)

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