Week 6 - Neuro Flashcards
causes of ACS
- 2 types
cerebral causes of ACS
- head injury
- oedema
- haemorrhage
- infection
- meningitis
- seizure
- stroke
- brain tumor
non cerebral causes of ACS:
- acidosis
- hypoxia
- hypotension
- hypoglycaemia
- hyperglcaemia
management of patient with ACS
DRSABCDE
Response - @
airway - @
Breathing - warm pink pt signs of Co2 retention
circulation - MAP
ACS pt investigations
- head CT
- pathology
- lumbar puncture
- insertion of ICP monitor
ICP normal value
ICP <15mmhg
signs of increased ICP
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
Management of raised ICP
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
primary brain injury
damage occurs at the time of impact
- can be focal of diffuse
- severity depends on extent of intial head injury
diffuse axonal injury
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
secondary brain injury
- occurs post initial insult may be due to: - hypoxia - hypotension - increased ICP - hypo/ hyperglycaemia - infection
cerebral oedema
swelling of the brain itself with or without associated bleeding
- leads to increased ICP
concussion
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
concussion - signs and symptoms
- ACS (+/-) LOC
- dizziness, drowsiness, confusion
- vomiting
- transient visual disturbances
- changes to vital signs are rare but possible
Base of skull fracture
can be associated with underlying cranial nerve and vascular injuries
Base of skull fracture - clinical manifestations
- raccoon eyes
- agitation
- battle sign (brusing behing the ear)
- CSF leak
Cerebral Contusion
- 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
Cerebral Contusion - signs and symptoms
- seizures
- personality changes
- aphasia
- LOC or Coma
Intercranial bleeding
- 4 types?
- intracerebral hemorrhage
- epidural hemotoma
- subarchnoid hemorrhage
- subdural Hamotoma
define each type of intercranial bleed
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
management of pt with intracranial bleed
pharmacological:
- hypertonic saline
- diuretic (frusemide)
- antibiotics
- sedatives
surgery:
- surgical evacuation
- clips
other:
- nutrition (will lose a lot of weight)
- fever treated aggressively (temp regulation)
Stroke - define
an acute neurovascular injury secondary to cerebral vascular disease
ischemic (80%)
heamorrhagic (20%)
FAST!!
stroke - risk factors
- hypertension
- increased age >55yrs
- family history
- smoking
- AF
- recent AMI
stroke - management
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
stroke - interventions
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
Thrombolysis inclusion criteria
- less than 3hrs since stroke symptoms
- BGL 2.7 - 22mmol/L
- evidence of ishcaemic stoke on CT scan
Thrombolysis exclusion criteria
- 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
