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Welliver Paper-Josh Flashcards

1
Q

The composition of the Cranial vault contains what 3 components which together determine ICP? for extra credit what % soed each make up?

A
  • Brain tissue (80%)
  • Blood (12%)
  • CSF (8%)
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2
Q

Brain is 80%

how much does it weigh in grams? and lbs? and % of tbw?

A
  • 1300g
  • 3 lbs
  • 2%
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3
Q

Blood is 12%

it receives how much of CO? how much total flow mL/min

A
  • 15-20% CO
  • 750mL/min
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4
Q

CSF 8%

how many mL in cranium and spinal cord total? how many mL in cranium ar any given time?

A
  • 150mL
  • 75mL
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5
Q

Normal ICP is what?

A

<= 10 mmHg

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6
Q

CSF production is by the _____ in the ____ _____ and makes approx ____ mL/day?

A
  1. Choroid plexuses
  2. Lateral ventricles
  3. 400mL
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7
Q

The ______ allows bilateral communication of internal carotid and vertebral artery blood flow?

A

Circle of Willis

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8
Q

Tumor locations are generally described as ______ or ______

A
  • supratentorial
  • Infratentorial
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9
Q

what is the CSF flow through the Brain?

A
  1. Choroid plexus (in lateral ventricles)
  2. Foromen of Monro
  3. 3rd ventricle
  4. Aqueduct of Sylvius
  5. Fourth Ventricle
  6. Foramen of Magendi & Luschka
  7. Cistern Magna
  8. Subarachnoid space and Spinal Column
  9. absorbed via Vill of SA space
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10
Q

CBF:

what is the avg CBF

(mL/g/min)

A

50mL/100g/min

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11
Q

CBF:

what is the total CBF (mL/min)

A

750mL/min

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12
Q

CBF:

what is the range of CBF?

(mL/g/min)

A

10-300 mL/100g/min

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13
Q

CBF:

the gray matter (neuronal bodies) receives how much of the CBF?

A

80mL/g/min

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14
Q

CBF:

thus the white matter (axons) receive how much CBF?

A

20mL/g/min

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15
Q

CBF:

alteration in CBF may be detrimental by drawing blood away from _____ areas or beneficial by providing more blood, and hence O2 to _____ areas

A
  • Ischemic
  • Ischemic
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16
Q

CBF:

CBF occurs throough what?

A

Circle of Willis

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17
Q

CBF:

list 3 factors that can affect CBF?

A
  1. Luxury perfusion
  2. Steal Phenomenon
  3. Inverse steal or Robin hood phenomenon
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18
Q

Factors that Affect CBF:

which factor is when perfusion excess of metabolic needs?

A

Luxury Perfusion

(you have too much your living the dream.. I’m rick james bitch)

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19
Q

Factors that Affect CBF:

Luxury Perfusion may be beneficial in healthy brains but may cause ______ in brains which have ischemic areas

A

“Steal Phenomenon”

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20
Q

Factors that Affect CBF:

w/ luxury perfusion what is 2 examples in which it may occur?

A
  1. Tumor Metabolites that cause vasodiltion in surrounding tissues
  2. VAAs decrease CMRO2 and Increase CBF
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21
Q

Factors that Affect CBF:

is Steal phenomenon detrimental or beneficial

A

Detrimental (bad bad bad)

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22
Q

Factors that Affect CBF:

what phenomenon is blood is stolen from ischemic areas of the brain by causing vasodilation in healthy areas of the brain.

A

Steal Phenomenon

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23
Q

Factors that Affect CBF:

w/ Steal Phenomenon what are 2 things that can cause it

A
  1. Increased PaCO2
  2. VAAs
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24
Q

Factors that Affect CBF:

why is Steal Phenomenon so detrimental?

A

Ischemic Brain tissue, which has already maximally dilated vessels due to released vasodilator subnstances, loses luxury perfusion due to global shunting of blood flow

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25
Q

Factors that Affect CBF:

what is the inverse steal or Robin hood phenomenon

A
  • Decreased pCO2 constrictes normal velles but not necessarily the ischemic areas d/t vasomotor paralysis. this is one rational for hyperventilating pt’s w. intracranial tumors associatd w/ increased ICP especially when administering VAAs whch cause Vasodilation
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26
Q

Circle of Willis:

what are the 5 (8 total) arteries of circle of willis?

A
  1. Anterior Cerebral Artery (2)
  2. Anterior Communicating Artery (1)
  3. Internal Carotid Atery (2)
  4. Posterior communicating Artery (2)
  5. Posterior cerebral artery (1)
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27
Q

Circle of Willis:

what 2 (3 total) arteries are connected to the circle of willis but not actually part of the circle of willis?

A
  • Basilar artery (1)
  • Vertebral artery (2)
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28
Q

Determinants of CBF:

PaCO2 has a ____ relationship

A

Linear relationship

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29
Q

Determinants of CBF:

PaCO2- a 1mmHg increase = what to CBF

A
  • 1-2 mL/100g/min increase in CBF
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30
Q

Determinants of CBF:

PaO2- there is a profound increase in CBF anly at a PaO2 ______mmHg?

A

< 50 mmHg

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31
Q

Determinants of CBF:

CPP equation

A

CPP= MAP - ICP (or CVP)

32
Q

Determinants of CBF:

what is normal CPP

33
Q

Determinants of CBF:

CPP < 50 mmHg means what to EEG

34
Q

Determinants of CBF:

A CPP= 25-40 mmHg does what to EEG

35
Q

Determinants of CBF:

CPP < 25 mmHg = what?

A

permanent brain damage

36
Q

Determinants of CBF:

what is Autoregulation? include the range!

A
  • The vasculature self regulates by vasoconstrction or vasodilation b/t a MAP of 60-160 mmHg
37
Q

Determinants of CBF:

Autoregulation- if the MAP is less than 60 or greater then 160mmHg what needs to happen in order to maintain anstant CBF

A

additional Vasoconstriction or vasodilation is needed

38
Q

Determinants of CBF:

once Autoregulation is out of range blood flow becomes solely dependent on ________ as the vasculature connot further constrict or dilate th maintain CBF.

39
Q

Determinants of CBF:

teh autoregulation curve is sifted to the _____ for pt’s w/ chronic HTN, therefore these pt’s require a higher MAP to Maintain CBF

40
Q

Determinants of CBF:

all VAAs _____ CBF in a dose dependent manner!

41
Q

Cerebral Metabolic Rate Oxygen Consumption (CMRO2)

CMRO2 is expressed as _____ of O2 consumed per ___ g of brain tissue per _____

A

mL

100g

min

42
Q

Cerebral Metabolic Rate Oxygen Consumption (CMRO2)

what is normal CMRO2

A

3-3.8 mLO2/100g/min

43
Q

Cerebral Metabolic Rate Oxygen Consumption (CMRO2)

what is the coupling effect w/ CMRO2 and CPP

A
  • Coupling is the direct linear relationship.
  • As CMRO2 increases or Decreases, CPP will also increase or decrease correspondingly
44
Q

Cerebral Metabolic Rate Oxygen Consumption (CMRO2)

the direct linear relationship b/t CMRO2 and CBF can be modified and altered by what?

A

Anesthestics

Anesthestic management

45
Q

Cerebral Metabolic Rate Oxygen Consumption (CMRO2)

ALL VAAs, BArbs, and Benzo do what to what to CMRO2

46
Q

Cerebral Metabolic Rate Oxygen Consumption (CMRO2)

VAAs decrease CMRO2 while ____ CPP disrupting the relationship of CMRO2 to CPP

A

Increasing

47
Q

What is the main energy source used by the brain?

48
Q

Glucose consuption by the brain averages wha?

A
  • 5mg/100g/min
49
Q

Determinants of CMRO2:

what are 3 main things that determine CMRO2

A
  • Coupling
  • Temp
  • Sz activity
50
Q

Determinants of CMRO2:

what does coupling do?

A
  • As metabolic demands increase so does cerebral blood flow and vice versa
51
Q

Determinants of CMRO2:

How does temp effect CMRO2

A
  • For each 1C decrease in temp there is 7-8% decrease in CMRO2
52
Q

Determinants of CMRO2:

temp: At 20C body temp an EEG is what?

A

flat showing no brain activity

53
Q

Determinants of CMRO2:

what do seizures do to CMRO2

A

Increase it

54
Q

ICP:

Normal ICP is what?

55
Q

ICP:

temporary increase in ICP can occur during what events in the OR

A
  • Coughing
  • Valsalva
  • HTN
56
Q

ICP:

sustained Elevated ICP >15 mmHg ______ CPP and increases the rick of Cerebral ischemia, and severely increased ICP may lead to brainstem heriniation through the foramen magnum

57
Q

ICP:

Intracranial Tumors are space occupying lesions and depending on their size and location may ______intracranial pressure

58
Q

ICP:

Preventing _____ in ICP is the main anesthestic Concern

59
Q

ICP:

__________ decreases CBF by causing cerebral vascular vasoconstriction which decreases ICP

A

HYPERventilation

60
Q

ICP:

thus decreasing CBV ____ ICP

61
Q

ICP:

_______ decreases Brain tissue water content therby decreasing ICP

62
Q

ICP:

______ and ______ catheters allow CSF to drain which decreases ICP

A

Ventriculostomy and intrathecal

63
Q

what are teh hallmark sigs of Cushings Reflex?

A
  • HTN
  • Bradycardia
64
Q

Why do you get the HTN and Bradycardia w/ cushings reflex

A
  • When CPP requirements exceed the arterial pressure hyppothalamic sympatheic reflex increases BP tp restroe CBF.
  • The Increased BP stimulates the Carotid bodies which lowers the HR
65
Q

what is Cushings Triad?

A
  • HTN
  • Bradycardia
  • irregular respiration
66
Q

Why does cushing triad occur?

A
  • after the cushing reflex with worsening elevation in ICP for whch the reflex cannot adequatly compensate
  • irregular respirations may ensue
  • this becomes the triad
67
Q

Cushings triad reflects sever increases in ICP and Severe Cerebral ischemia and Impending ______

A

herniation

68
Q

Just a fact

It is estimated that __% of pts w/ elevated ICP display all 3 components of Cushiings triad

69
Q

Supratentorial Tumors occupy what area

A

midbrain and cerebral cortex

70
Q

Infratentorial tumors occupy what areas?

A
  • cerebellum and brainstem
71
Q

Positioning risk:

Sitting

72
Q

Positioning risk:

lateral oblique position

A

Brachial plexus injury

73
Q

Positioning risk:

prone

74
Q

Positioning risk:

Supine

A
  • head and neck rotation or extension
75
Q

thats it for that I will make a separte one for the question on the paper!!!

Principles 4 (20 decks)

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