week 9 flash part 1 Flashcards
what is a normal ICP
under 15mmHg
higher than 20 = ischemia and brain damage
whats the difference between a primary and secondary brain injury
primary injury: time of injury (initial ouch)
secondary injury: several hours to days after injury
what is a normal CPP
60-80
how do you calculate CPP
BP - ICP
what should you keep SBP at to increase CPP
160
what is an external ventricular drain (EVD)
ICP monitor
what are the three ways the body compensates for IICP
brain tissue: dura becomes distended and compresses the tissue
blood: cerebral vessels vasoconstriction which decreases perfusion to the brain
CSF: production slows down and some is displaced onto the spinal column
why does IICP increase H+ concentration
because lactic acid will be released due to PaCO2 (to dilate vessels so more O2 can enter the brain)
- lactic acid makes the body super acidic
what do you need to monitor CO2 and O2 levels in a patient
you need and ABG
what is cushings triad and what does it mean
- wide pulse pressure
- Bradycardia
- irregular reps
medical emergency, means compression on the brain stem
why would you see changes in temp with cushings triad
because the hypothalamus will be compressed
what is an epidural hematoma
bleeding outside the dura
what is a subdural hematoma
bleeding inside the dura
which diagnostic test will confirm cerebral edema or a re bleed in a brain trauma patient
CT
what diagnostic test checks for aneurism and stroke
angio
which diagnostic test determines a seizure
EEG
with LP, where in the spine does the needle go
L3/L4
what are some signs of complication with a LP
shooting pain/tingling, headache that doesn’t improve
what does a trans cranial doppler look for
backflow/vasospasm in intracerebral arteries
when would you use corticosteroids for the brain
only for brain tumours, not for diffuse cerebral edema
why is it bad if an IICP patient has decreased O2
it could result in vasodilation and increase ICP
what is the frontal lobe responsible for
intellect, personality, decision making
what is the parietal lobe responsible for
motor activities, motor speech, sensory discrimination
what is the occipital lobe responsible for
eyes to opposite side, body awareness, writing, visual reception
what are the main things you do at the scene of a brain trauma accident
- maintain airway
- stabilize spine
apply pressure to external bleeding and warm blankets
what is the temporal lobe responsible for
reading, memory, hearing, smelling, taste
what do you assess for in an initial accident of a brain trauma patient
- rhinnorhea
- ottorrhea
- scalp wounds
what does a nurse do with a neuro trauma patient once theyre at the hospital
- O2
- establish 2 large bore IV
- warm blankets
- frequent VS and neurochecks
- monitor
what is port auricular ecchymosis
battle sign, bruising behind ears
can mean basilar skull fracture
what is bilateral periorbital ecchymosis
raccoon eyes, bruising around the eyes
what is the main complication of skull fracture
Dural tear (CSF leak)
increases risk of meningitis
how can you tell if nasal drainage is CSF
halo sign
what is a brain contusion
bruising of the brain within one focal area (right where skull is fractured)
what causes a diffuse axonal injury
coup-contra-coup injury
what is a diffuse axonal injury
Brain shaking like jello, tears all axons in half
what is the main complication of a DAI
90% of people with a DAI remain in a vegetative state
whats the difference between an epidural hematoma and a subdural hematoma
epidural: usually arterial so it bleeds fast, medical emergency
subdural: usually venous, slower onset
what is the main thing we do to manage hydrocephalus
use shunt from ventricle into perineal cavity which releases fluid into the body to be reabsorbed
what is a burr hole usually used for
a subdural hematoma
what is stereotactic radio surgery
radiation used to destroy brain tumour, patients head held still by stereotactic frame
- uses high dose radiation to pinpoint exact spot where tumour is
