Block 4
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| show | Transient alteration in mental status following direct indirect blow to the head
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| Concussion Symptoms *****TEST | show 🗑
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| Concussion Symptoms *****Test | show 🗑
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| Concussion RED FLAGS teaching RETURN ER *****TEST | show 🗑
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| show | symptoms continue after injury up to 3 months amnesia retrograde/antegrade predictive of PCS
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| show | F/u with physician, limit physical and mental activity sleep and nutrition
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| show | neurologic deficits related bleeding bruising cerebral edema seizures hemiparesis, aphasia personality changes decreased loc or coma
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| Left sided injury has right sided motor function loss | show 🗑
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| Otorrhea, battle signs, raccoon eyes suspect what | show 🗑
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| What is a risk for CSF leakage and what are symptoms | show 🗑
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| show | Never suction through nose or attempt to place NG tube.
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| show | Headache nausea vomiting, decreased loc, pupillary changes, motor deficits (hemiparesis, posturing,) seizures
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| show | 2-3 days acuteHeadache sudden or progressive nausea, vomiting, decreased loc, hemiparesis. 2-14 subacute headache, ataxia increased confusion, slow cognition, decreasing loc, nausea vomiting. 2 week month chronic and tiredness.
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| show | "talk and die" loss of consciousness at time of injury the lucid interval followed by loss of counsiousness
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| Epidural TX | show 🗑
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| supratentorium vs intratentorium | show 🗑
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| show | watch for vision field cuts "how many fingers do I have up" teach patient to turn head when viewing sides. (optic nerve II)
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| show | ABC, neuro assessment, I&O, hemodynamics, temperature, ICP, CPP, monitor drains , assess pain , nutrition, periorbital edema cold compresses ( hob 30 ok for supratentorium may be flat for intratentorium may order flat
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| show | Monitor for infection, csf leakage, bleeding, DVT, PE, pneumonia, GI bleed, ARDS, Atelectacis
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| show | DI decreased ADH from anterior pituatory gland polyuria >200 ml for 2 hours notify doc if it appears another 200 SG nml 1.003 1.030 will be low replace fluids---SIADH blood osmolarity >320 dilutional hyponatremia. Cerebral salt wasting loss of salt
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| show | Headache most common in the morning, focal defficits
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| show | a warning sign of stroke, micro clot that has desolved, test MRI and Cardiac
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| show | The signs and sympIf the carotid system is involved, patients may have a temporary loss of vision in one eye (amaurosis fugax)hearing deficits, speaking deficits. considered warning sign of stroke
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| show | HTN #1, Race-African American, Hispanic, hypothyroidism, obesity, sedentary lifestyle, family hx, age over 65, CAD, smoking, Aortic arch or carotid artery disease, preeclamsia, gestational DM, woman higher mortality rate-
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| show | Plavix neutropenia, thrombotic thrombocytopenia purpura, call for fever chills, sore throat, unusual bleeding , or bruising, Ticlopidin neutropenia cbc every 2 weeks, Dyridamole not preferred but also has vassdialating effect good for pad,cad,Afib warfarn
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| Carotid stenosis major surgery | show 🗑
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| show | carotid and vetebral
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| Ischemica stroke most common causes | show 🗑
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| Homonculus Motor | show 🗑
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| Middle cerebral artery most common stroke | show 🗑
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| show | harder to assess, rt sided paralysis,impaired speech language aphasias, slow performance, aware of deficits,depressed impaired comprehension to language and math
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| right side stroke | show 🗑
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| show | ABC's, stroke rating scale (fast,NIH stroke scale) Time of symptoms onset, Vital signs 02 sat, Labs, plattlet, cant delay blood glucose, PT, INR, PTT, electrolyte, renal function, cbc, troponin, ekg, noncontrast or mri of head interpret in 45 min
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| show | Fast face, arms, speech, timing or NIH loc, visual, skills, sensation, and inattention, language, cerebral integrity. 0-42 points higher score more neuro impairment
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| Basic stroke assessment | show 🗑
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| What important point about bp and stroke | show 🗑
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| show | don't unless <60 >140-180
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| show | 24-48 hours after
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| TPA treatment requirements | show 🗑
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| show | Hemorhagic stroke, BP >185/110, previous trauma,active bleeding, pregnancy, seizures, blood glucose <50 or >400
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| TPA | show 🗑
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| TPA monitoring | show 🗑
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| TPA administration do's and dont's | show 🗑
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| show | No anticoagulants or ASA unitl 24hours after stroke-Begin ASA 24-48 hours after stroke
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| MAP = | show 🗑
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| show | MAP-ICP
normal CPP 70-100
head injury ideal 50-70
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| show | manitol,head of bed, neutrol neck, control vomiting (control ICP), calm quiet environment, no vegals, hypertonic normal saline, no lumber pressure, prophalaytic seizure, fever control shivering, csf, monitoring and drainage. hyperventilation vent
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| Phenytoin | show 🗑
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| show | 150mg/min
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| show | high risk infection aseptic technique, don't flush, wash hands clear dressing, review site redness color of drainage CSF should be clear
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| show | intracebral : htn not much you can do
subarachnoid : risk avm are congenital but not gentic risk for meningitis
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| Cerebral aneurysms s/s | show 🗑
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| show | "the worst headache of my life" ruptured aneurysm, lumbar puncture will show RBC, LOC, vomiting, CN deficits III, IV, VI, stiff neck photophobia, hemiparesis, hemiplegia, aphasia, congnitive deficits, seizures, widened pulse pressure, bradycardia, sys htn
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| Subarachnoid treatment | show 🗑
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| show | <160/80 mean >65
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| show | sudden dever headache, n/v, change in loc, new neuro deficits.
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| show | CCb day 2 nimodepine only for vasospasm 60mg q3hrs for 21 days-risk of vasospasms 2-14 days
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| show | blood in csf plugs arachnoid villi, ventriculostomy acute.
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| show | drying someone out
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| show | Main reason withdraw from meds, ETOH, drugs, stroke head trauma, brain tumor, cerebral edema, metabolic disturbances, infections meningitis, encephalitis
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| Tonic clonic seizures | show 🗑
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| Status epilepticus is defined as | show 🗑
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| Treatment | show 🗑
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| Status epilepticus meds | show 🗑
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| Types of Spinal cord injury | show 🗑
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| show | central cord syndrome "can walk to the door but cant open it"
Anterior cord syndrome "loss of motor, pain temp, below injury with intact touch, vibration touch,
Brown sequard syndrome loss of motor function position and vibratory sense ipsilateral
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| show | Emergency management ABCDE approach-Airway maintain neutral airway-Breathing ensure patient is breathing o2, Circulation pulse,BP, disability neuro check, Exposure remove clothing to assess whole body ---maintain c spine until cleared
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| show | C3,C4, c5- keep diaphragm alive Still monitor 6 and below monitor because edema can spread and require vent
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| Spinal cord Emergency | show 🗑
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| Cervical Traction | show 🗑
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| Medications indicated in SCI <8hrs old | show 🗑
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| show | T6 or higher loss of sympathetic response below to heart and peripheral vascular resistance. vasodilation below, main sign bradycardia,hypotension unopposed vegal tone, hypothermia patient must be kept warm fluid trapped in lower extremities hy
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| show | Norepinephrine, neosynephrine, atropine to increase heart rate wrap lower extremities to increase bp abdominal binders,
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| show | Loss of all neuro activity below level of injury flaccid paralysis, loss of pain, touch pressure, no somatic or visceral sensation, Atonic cant void, recovery 1-2days -4-6weeks, recovery hyperreflexia spinal reflex +bilateral babinskis anal wink
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| show | injury to T6 and above is risk factor, only seen in post spinal shock resolved, noxious stimuli causes overreaction sns-causing massive constriction below injury leading to increased HTN, and bradycardia
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| show | elevate hob 30: severe htn, headache, flushed face, nasal congestion, anxiety, remove all clothes binders, pressure divices and sit them up first, use anesthetic for tx of bladder distention and fecal impaction, find and remove noxious stimuli
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| show | If you cant find source may need antihypertensive medication alpha adrenergic blocker, dozasosin, terazosin, ccb,education to patients good skin care no tight clothing, belts, pants, fiber, and monitor bp
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| Guillian Barre autoimmue | show 🗑
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| show | Assess for progressive paralysis, paresthesis, pain muscle weakness, difficulty eom, dysphagia, diplopia, bladder bowel dysfunction, autonomic dysfunction hypo hyper tension
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| show | Lumbar puncture for CSF, plasmaphoresis to remove antibodies risk for bledding, IV IGg, 9,10, 12 may be impaired cause aspiration may need NPO ROM, monitor DVT, skin breakdown and eye care
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| Lumbar puncture procedure | show 🗑
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| Myelogram | show 🗑
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| show | NPO 4-6 hours prior to exam Obtain baseline neuro assessment; mark peripheral pulses Maintain bedrest for 6-8 hours Observe puncture site for bleeding, hematoma formation. Monitor peripheral pulses if femoral access Force fluids to clear contrast dye
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| Electroencephalography | show 🗑
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| . •CN I (olfactory) sense of smell •CN II (optic) vision - can have patient ID how many fingers you are holding up, use an eye chart, monitor for visual field cuts by holding up fingers in upper and lower quadrants while the patient looks at your nose | show 🗑
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| show | •CN IX (glossopharyngeal) palate, pharynx ("Open your mouth, stick out your tongue and say ahhhh.")
•CN X (vagus) gag reflex
•CN XI (spinal accessory) shoulder shrug
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| show | Pay special attention to assessment of CNs II, III, IV, & VI. These are the most frequently checked during a brief neuro assessment.
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| show | •Arousal and wakefulness - wakefulness reflects activity of the reticular activating system •Content of consciousness - cognitive mental functions; reflects cerebral cortex activity
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| Phenobarbital (Luminal), Phenytoin (Dilantin), Fosphenytoin (Cerebyx), Carbamazepine (Tegretol), Valproate (Depacon), Valproic acid (Depakene), Clonazepam (Klonopin), Gabapentin (Neurontin), | show 🗑
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| Take with food to decrease GI irritation, but avoid milk and antacids (impairs absorption) Do not discontinue medication without consulting physician Avoid alcohol or other CNS depressants Avoid over-the-counter medications - | show 🗑
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| show |
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| show | Monitor patients with pre-existing HF very carefully - shift in fluid may cause pulmonary edema.Monitor serum osmolality - keep osmo at approximately 310 - 315 mOsm
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| Manitol cont | show 🗑
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| show | Later stage of increased ICP
Cushing's response occurs first - the systolic BP rises causing a widened pulse pressure and the patient's heart rate slows
If ICP is not managed the patient may go on to exhibit the
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| show | s/s of Cushing's Triad:
Systolic hypertension with widened pulse pressureBradycardiaChanges in respiratory pattern
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| S/S of uncal herniation | show 🗑
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| Remember that suctioning can increase ICP. Suction only when needed; keep suction to <10 seconds; be sure to pre and post oxygenate | show 🗑
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| Neuromuscular blocking agents (vecuronium, atracurium | show 🗑
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| EMTLA | show 🗑
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| show | Crimes, commumincable diseases, call forensic try to hold evidence bloody shirt document evidence and lable came from who chain of custody
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| Surveys : what are components.............TEST | show 🗑
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| show | Breathing Assess ventilation auscultate lungs absent BS consider tension pneumothorax no x ray needed supplemental 02 abu bahg
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| Circulation | show 🗑
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| Disability | show 🗑
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| Enviroment | show 🗑
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| show | Fulle set of vitals focused adjunts are ekg, sats, cxr, foley, cath, ng tube, lab diagnostics, tetanus prophalatics, Give comfort measured, pqrst pain assessment pain scale (O-10) FACES, FLACC, HISTORY full head to toe amble, inspect posterior surfaces,
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| show | after complete intervention and evaluation
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| show | decreased bp after 20 weeks lay on lt side any changes in loc abnormal, assess fetal heart tones, increased risk of aspiration decreased pulmonary reserve from fetal 02 consumption
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| Tetanus Prohphylaxis | show 🗑
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| show | Three or more doses and 6-10 yr since last dose
No prophylaxis needed
Td or Tdap* (Tdap preferred for ages 11-18)
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| show | Obstructive shock caused by PE or Cardiac Tamponade
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| SHOCK S/S | show 🗑
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| collaborative care urine | show 🗑
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| show | restore fluid crystolloids, control bleeding treat cause elevate extremites
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| show | Distributive shock results from excessive vasodilation and the impaired distribution of blood flow can be septic anaphylactic, neurogenic
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| Anaphylatic shock treat | show 🗑
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| Neurogenic shock | show 🗑
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| show | dopamine >20mg acts as alpha constricts
dopamine 5-10 acts as beta inotrope neosyneprhine constrction without effects on heart
norepinephrine alpha and beta
epinephrine, vassopressin
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| Vasopressors | show 🗑
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| show | dobutamine improves contractility, dopamine 5-10 mcg min admiroane can cause neutropnea-nitroprisde reduces preload and after load more then 48 hours measure cyanide levels.
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| show | Flexion forward force head anterior -hyperextension head pushed back posterior injury-compression diving straight down- rotation twisting displacement of vertebrae
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