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N232-U2-HEAD INJURY

HEAD INJURIES

QuestionAnswer
THE INNER PART OF THE BRAIN IS ASSOCIATED WITH CONTENT OR MOVEMENT CONTENT
THE OUTER PART OF THE BRAIN IS ASSOCIATED WITH CONTENT OR MOVEMENT MOVEMENT
INNER CONTENT
OUTER MOVEMENT
AROUSAL COMES FROM THE BRAIN STEM, SPECIFICALLY FROM THE RETICULAR ACTIVATING SYSTEM
THE RETICULAR ACTIVATING SYSTEM IS RESPONSIBLE FOR AROUSAL
IF A PATIENT IS IN A COMA WHAT SCORE/RANGE WOULD THEY HAVE ON A GLASGOW COMA SCALE 3-8
WHAT IS THE BEST SCORE YOU CAN GET ON A GLASGOW COMA SCALE 15
THE RETICULAR ACTIVATING SYSTEM IS LOCATED IN THE OUTER OR INNER BRAIN OUTER
A BUMP TO THE HEAD COULD AFFECT AROUSAL BECAUSE OF DAMAGE TO THE RETICULAR ACTIVATING SYSTEM
AROUSAL COMES FROM OUTER
CONTENT COMES FROM INNER
AROUSAL BUT NO COGNITION IS PERSISTENT VEGETATIVE STATE
NO MOTOR BUT UNDERSTANDS THINGS LOCKED-IN SYNDROME
HOW MIGHT A PATIENT WITH LOCKED-IN SYNDROME COMMUNICATE WITH OTHERS THROUGHT THE EYES
BRAIN DEATH IS LEGAL DEATH
IS AROUSAL PRESENT IN PERSISTENT VEGETATIVE STATE YES
WHAT IS NOT PRESENT IN A PERSISTENT VEGETATIVE STATE COGNITION
WHAT IS PRESENT IN LOCKED-IN SYNDROME COGNITION
TRAUMA, STROKE/HEMORRHAGE, INFECTION AND NEOPLASMS ARE ALL WHAT TYPE OF CAUSE OF ALTERED LOC STRUCTURAL
HYPOGLYCEMIA, HYPOXIA, CHEMICAL TOXINS, CHANGES IN BODY TEMP ARE ALL METABOLIC CAUSES OF ALTERED LOC
THE OUTER BRAIN FUNCTION CONTENT
THE INNER BRAIN FUNCTION AROUSAL
INNER BRAIN---RAS--- AROUSAL
OUTER BRAIN--- CONTENT
THE PATIENT THAT RESPONDS TO STIMULI IS ALERT
THE PATIENT THAT NEEDS CUES OR THEIR JUDGMENT IS OFF IS CONFUSED
THE DROWSY PATIENT THAT NEEDS STIMULATION LETHARGIC
RESPONDS ALERT
NEEDS CUES CONFUSED
DROWSY LETHARGIC
VERY SLOW TO RESPOND TO STIMULI AND NEEDS CONSTANT STIMULATION TO MAINTAIN RESPONSE OBTUNDED
A PERSON IS ‘OBTUNDED’ IF THEY NEED WHAT CONSTANT STIMULATION TO MAINTAIN A RESPONSE
A PATIENT THAT ONLY MOANS OR GROANS TO STIMULI IS CONSIDERED TO BE STUPOROUS
LOC ASSESSMENT INCLUDES MENTAL STATUS, MOTOR, SENSORY AND GLASGOW COMA SCALE
MENTAL STATUS, MOTOR, SENSORY AND GLASGOW COMA SCALE ARE ALL PART OF LOC ASSESSMENT
AN INCREASED SCORE ON THE GLASGOW CORRELATESWITH A INCREASED STATE
A DECREASED SCORE ON THE GLASGOW CORRELATES WITH A DECREASED STATE
RIGID EXTENSION OF ALL FOUR EXTREMETIES WITH HYPERPRONATION OF FOREARMS DECEREBRATE POSTURE
DECEREBRATE POSTURE TURNS THE LEGS ___ AND THE ARMS/WRISTS ___ LEGS IN, ARMS/WRISTS OUT
DECORTICATE POSTURE AND DECEREBRATE POSTURE BOTH INCLUDE EXTENSION OF LOWER EXTREMITIES
THE ARMS ARE POSITIONED HOW IN DECORTICATE POSTURING ADDUCTED, POINTED IN TO THE ‘CORE’
THE ARMS ARE POSITIONED HOW IN DECEREBRATE POSTURING RIGIDLY EXTENDED WITH HYPERPRONATION OF FOREARMS
WHICH POSTURING INDICATES A MORE SERIOUS CONDITION DECEREBRATE
WITH DECEREBRATE YOU DON’T CELEBRATE…WORSE CONDITION
DECEREBRATE POSTURING INDICATES DISRUPTION OF MOTOR FIBERS IN THEMI D BRAIN AND BRAIN STEM
IN DECORTICATE POSTURING THE ARMS ARE PULLED IN TO THE CORE
IN ASSESSING PUPIL ACCOMMODATION THE CLOSER THE OBJECT IS TO THE PUPIL THE SMALLER THE PUPIL GETS
HANDS CURLED INTO AN E DECEREBRATE
HANDS BROUGHT UP TO THE CHEST DECORTICATE
WHICH POSITION OF THE HAND INDICATES A MORE SERIOUS CONDITION CURLED INTO AN E
X-RAY STUDIES, CTS AND MRIS ARE USED TO DETERMINE WHAT TYPE OF LOC CAUSE STRUCTURAL
AN EEG ANALYZES THE CORTEX
IF AN EEG DOESN’T SEE ANY CONTENT WHAT TEST WILL BE PERFORMED NEXT EP
EP STANDS FOR EVOKED POTENTIAL
WHICH TEST CAN SEE THE BRAINSTEM EP
AN EEG MEASURES ELECTRICAL ACTIVITY OF THE CORTEX
AN EP IS USED TO RULE OUT DRUGS AS A CAUSE OF COMA
DURING AN EP THE BRAIN IS STIMULATED WITH LIGHTS, SOUND AND/OR PAINFUL STIMULI
WHICH TEST IS USED TO DETERMINE THE PRESENCE OR ABSENCE OF BRAIN STEM ACTIVITY EP
EP GOES DEEP
OUTER MOVEMENT
INNER CONTENT
WHICH TEST IS DONE INTERNALLY, AN EP OR AN EEG EP
A DOPPLER ULTRASONOGRAPHY IS USED TO SEE WHAT BLOOD SUPPLY
A CEREBRAL ANGIOGRAPHY IS USED TO SEE ARTERIES IN THE BRAIN
WHAT IS USED DURING A CEREBRAL ANGIOGRAPHY CATHETER WITH CONTRAST
WHAT TEST IS USED TO MEASURE ICP LUMBAR PUNCTURE
WHAT TEST USES A NEEDLE AND CATHETER INSERTED IINTO THE SPINE TO TAKE PICTURES MYELOGRAPHY
DOPPLER ULTRA SONOGRAPHY TO SEE BLOOD SUPPLY
CEREBRAL ANGIOGRAPHY CATHETER WITH CONTRAST TO SEE ARTERIES IN BRAIN
LUMBAR PUNCTURE DRAW FLUID TO MEASURE ICP
MYELOGRAPHY NEEDLE & CATHETER TO TAKE PICTURES
A LUMBAR PUNCTURE IS PERFORMED BETWEEN THE 3RD AND 4TH LUMBAR
A NORMAL ICP IS 8-18 OR 20
AN ICP IN THE TEENS IS CONSIDERED TO BE NORMAL
AN ICP CATHETER IS INSERTED TO DETERMINE PRESSURE IN THE VENTRICLES
WHEN ASSESSING FOR THE ICP WE USE WHAT THE AVERAGE SHOWN
HOW DOES THE BRAIN INITIALLY RESPOND TO INCREASED ICP COMPLIANCE
COMPLIANCE MEANS THE BRAIN ADAPTS TO THE PRESSURES
ICP PATHOPHYSIOLOGY INCLUDES COMPLIANCE, AUTOREGULATION AND DISPLACEMENT OF BRAIN TISSUE
WHICH RESPONSE OCCURS FIRST WHEN ICP RISES COMPLIANCE
WHICH RESPONSE WILL CONSTRICT BLOOD FLOW TO THE BRAIN AUTOREGULATION
THE SHEARING OF AXONS DISPLACEMENT OF BRAIN TISSUE
DISPLACEMENT OF TISSUE INTO AN AREA IT’S NOT MEANT TO BE IS HERNIATION
THE BLOOD SUPPLY TO THE OUTER PORTIONS ARTERY
THE BLOOD SUPPLY TO THE INNER PORTIONS VENOUS
WHICH IS AN EMERGENCY, A BLEED FROM THE OUTER OR THE INNER OUTER, ARTERY
A BLEED IN THE INNER, VENOUS SYSTEM WILL PROGRESS SLOW OR FAST SLOW, VENOUS
WHICH CONDITION IS MORE EMERGENT, AN ARTERIAL OR VENOUS BLEED ARTERIAL
A LACERATION TO THE OUTER BLOOD SUPPLY IN THE HEAD IS A MEDICAL EMERGENCY
VE’N’OUS I’NN’ER
‘A’RTERIAL ’O’UTER
C02 IS A POTENT VASODILATOR
WHY WOULD WE HYPERVENT A PATIENT WITH INCREASED ICP HYPERVENTING INCREASES C02 AND THE CO2 WILL DILATE THE VESSELS AND LOWER THE ICP
CEREBRAL EDEMA IS FLUID
BRAIN SWELLING IS AN INCREASE IN BLOOD VOLUME
INCREASED ICP AND ALTERED LOC ARE EARLY OR LATE SIGNS OF INTRACRANIAL PRESSURE PROBLEMS EARLY
CUSHING’S TRIAD, RESPIRATORY CHANGES AND POSTURING ARE EARLY OR LATE SIGNS LATE
RESPIRATORY CHANGES INDICATE LATE OR EARLY SIGNS OF INCREASED ICP LATE
WHAT IS CUSHING’S TRIAD INCREASE IN SYSTOLIC, DECREASE IN DIASTOLIC AND DECREASE IN HR
A WIDE PULSE PRESSURE WITH SLOWING PULSE IS CALLED CUSHINGS TRIAD
A WIDE PULSE PRESSURE AND DECREASED PULSE ARE EARLY OR LATE SIGNS OF INCREASED ICP LATE
WHAT IS THE FIRST THING YOU WILL SEE WHEN ICP RISES AN INCREASE ON THE MONITOR
WHAT WILL YOU SEE AFTER THE MONITOR ICP RISES ALTERED LOC
WHAT ARE THE CARDIOVASCULAR SYMPTOMS OF INCREASED ICP CUSHING’S TRIAD-WIDE PULSE PRESSURE AND DECREASED HR
IN WHAT ORDER WILL SIGNS OF INCREASED ICP OCCUR NUMBER ON MONITOR WILL INCREASE, THEN LOC CHANGES AND THEN CV CHANGES
CV CHANGES WILL BE SEEN AFTER LOC CHANGES
IS AN IRREGULAR RESPIRATORY PATTERN AN EARLY OR LATE SIGN OF INCREASED ICP LATE
POSTURING, CUSHING’S AND RESPIRATORY CHANGES ARE ALL LATE SIGNS OF INCREASED ICP
WHEN FLUID IS PRESENT IT IS CALLED EDEMA
WHAT IS USED TO TREAT EDEMA DIURETICS
WHAT IS THE MOTHER OF ALL DIURETICS MANITOL
WHEN BLOOD VOLUME TO THE BRAIN IS INCREASED WE GIVE VASOCONSTRICTORS
WHAT IS COMMONLY DONE WHEN WE GIVE VASOCONSTRICTORS HYPERVENT TO BALANCE CONSTRICTION AND DILATION
COUGING, VOMITING, DEFECATION AND VALSALVA MANEUVER ARE ALL ACTIVITIES THAT WILL HAVE WHAT AFFECT ON ICP INCREASE
WHEN THE FEET ARE HIGHER THAN THE HEAD WHAT WILL HAPPEN TO ICP INCREASES
WHEN THE HEAD IS HIGHER THAN THE FEET WHAT WILL HAPPEN TO ICP DECREASES
ACTIVITIES THAT DECREASE ICP INCLUDE HYPERVENTING, POSITIONING SO THAT THE HEAD IS HIGHER THAN THE FEET AND CNS DEPRESSANTS/SEDATION
HEAD INJURIES HAVE WHAT EFFECT ON OXYGEN AND GLUCOSE INCREASED NEED
WHAT IS THE MAIN GOAL OF CARE IN THE INITIAL MANAGEMENT OF HEAD INJURIES ABC’S, IMMOBILIZE HEAD & NECK
WHAT IS THE ONGOING MANAGEMENT PRINCIPLE OF BRAIN INJURY CARE MAINTAIN CEREBRAL PERFUSION, PREVENT INCREASE IN ICP
WHAT IS THE PROGNOSTIC PRINCIPLE OF HEAD INJURY DURATION OF COMA
WHAT IS THE PRIMARY GOAL OF BRAIN INJURY CARE SELF CARE IS THE PRIMARY GOAL
MANNITOL IS USED FOR MOVING FLUID OUT OF THE BODY
MANNITOL WILL HAVE WHAT EFFECT ON ICP LOWER IT BY LOWERING VOLUME
WHAT SHOULD BE MONITORED CLOSELY WHEN USING MANNITOL OUTPUT AND ELECTROLYTES
DECREASED POTASSIUM RESULTS IN WHAT CHANGE ON AN EKG DEPRESSED T WAVE
WHAT ARE THE S/S OF DECREASED POTASSIUM CONFUSION, IRREG RHYTHM, RESPIRATORY PARALYSIS, ILEUS, NAUSEA AND WEAKNESS
WHAT ARE THE S/S OF INCREASED POTASSIUM FACIAL NUMBNESS, DIARHEA, ASYSTOLE, RESPIRATORY ARREST
DIABETES INSIPIDUS AND SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE RELEASE ARE THE RESULT OF DAMAGE TO THE PITUITARY GLAND
DIABETES INSIPIDUS IS THE DECREASE OF ____ THAT LEADS TO THE LOSS OF ______ ADH, H20
ADH IS INCREASED OR DECREASED IN DIABETES INSIPIDUS DECREASED
HOW ARE DIABETES INSIPIDUS AND SIADH ALIKE ADH IMBALANCE
INCREASED ADH RESULTS IN RETENTION OF WATER
DECREASED ADH RESULTS IN LOSS OF WATER
A PATIENT WITH DI WILL LIKELY BE HYPER OR HYPO-VOLEMIC HYPOVOLEMIC
REMEMBER THAT WITH’ DI’ YOU HAVE ’DEHY’-DRATION
TOO MUCH ADH WILL CAUSE WATER RETENTION
‘SI’ADH RESULTS IN ’HI’ RETENTION
POTASSIUM AND THE T WAVE HAVE A DIRECT RELATIONSHIP
WHEN POTASSIUM IS HIGH THE T WAVE IS HIGH
WHEN POTASSIUM IS LOW THE T WAVE IS LOW
WHEN POTASSIUM IS HIGH THE BOWELS ARE HIGHLY ACTIVE
WHEN POTASSIUM IS LOW THE BOWELS ARE SLOW
PULLING INTRACRANIAL FLUID OUT THRU VENTRICULOSTOMY IS CONSIDERED A EXTREME MEASURE
BEFORE VENTRICULOSTOMY IS PERFORMED WHAT MEASURES SHOULD BE TRIED FIRST HOB UP, HYPERVENT
A CONTUSION OF THE BRAIN STEM WILL RESULT IN THE LOSS OF WHAT VITAL REGULATION
AN IMPACT TO THE HEAD WILL RESULT IN WHAT TYPE OF BRAIN INJURY PRIMARY
THE PRIMARY HEAD INJURY WILL RESULT IN THE SECONDARY INJURIES
AN EPIDURAL HEMATOMA IS EASY TO FIX BUT A LIFE-THREATENING BLEED
IS AN EPIDURAL HEMATOMA VENOUS OR ARTERIAL ARTERIAL
SUBDURAL HEMATOMAS ARE WHAT TYPE OF BLEED SLOW, VENOUS
WHICH IS A DEEPER BLEED, EPIDURAL OR SUBDURAL SUBDURAL
ARTERIES ARE IN THE EPIDURAL
VEINS ARE IN THE SUBDURAL
Created by: Lori Dobrisky