ICP
Help!
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| 1st sign of increased ICP | change in mention
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| last thing that happens before death w/ increased ICP? | herniation
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| cranial nerve 9 and 10 test | cough an gag
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| CN 5 | corneal reflex and blink
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| CN 3 | pupillary response
do every day
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| Oculocephalic Reflex testing nerves? | contraindicated w/ pt.'s with SCI
if pt. keeps looking at examiner= intact reaction (positive)
if eyes turn were head is going = absent abnormal brain stem function
3,6,8
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| Cushings triad | irregular resp.(chynes stroke)
bradycardia
and increased SBP w/ widended pulse pressure
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| lumbar puncture | L3 and L4
-contraindicated in increase ICP
- can do it judicially to drain CSF
-lateral recumbent position
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| decrease glucose in CSF? | bacterial infection, meningitis
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| regular ICP? | 0-15 regular
>=20mmgh for >5min is increased ICP
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| CPP normal range | 60-100
>100 is cerebral HTN
<70 cerebral ischmia
<40 irreversible brain ischmia
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| kernig's | pain in the neck when extending the knee
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| brudinski? | involuntary flexion of the hip when the neck is flexed towards the chest
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| what do we level ventricular drain ? | external: tragus
inside: foraman of monro
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| what fracture do we see raccoon eyes and battle signs | basilar skull fracture
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| epidural hematoma is ____ bleed? | arterial bleed
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| pt. says worst HA of my life? | subarachnoid hemmorhge
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| ipsilateral pupil change, what hematoma | epidural
(same side ipsilateral pupil change)
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| which one occurs in minutes to days? | subdural
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| has 3 categories - involves venous artery -highest mortally rate -torn cortical vein most common cause -occurs within hours to days | subdural hematoma
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| what is the most common cause of intra cerebral hematoma? | uncontrolled HTN
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| safest rate to drain CSF? | 480/500ml/day
20ml/hr
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| uncle herniation early signs | early: babinski, cheynes stokes, ipsilateral dilated pupil
late: central-lateral hemiplasia,
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| cerebellar tonsil herniation ? | decreased RR, bradycardia, decreased HR
and cushngs
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| subdural, what kind of bleed? | VENOUS
S.V
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| Epidural, what kind of bleed? | arterial bleed
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| pt. comes in and says having worst HA of their life, what kind of hematoma? | SAH
subarachnoid hemmorahe
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| SAH tx: to prevent vasospasm? | nimodipine
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| SAH is the rupture of the circle of? | SAH IS RUPTURE OF THE CIRCLE OF WILLIS
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| SCI: |
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| INJURY ON S2 S4= | SEXUAL DYSFUNCTION
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| PT. SCI BELOW T12? | ERECTION BUT NO EJACULATION
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| PT. SCI ABOVE T11? | ERECTION , 10% EJACULTION
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| AUTONOMIC DYSREFELXIA? | ABOVE T6
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| C1 to C3 ? | VENTILATOR DEPENDENT
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| C4 to C5 | AKA pt. needs phrenic nerve stimulator to breath
PHRENIC NERVE INVOLVEMENT
May need phrenic nerve pacemaker
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| BELOW C5 – T6 | DIAPHRAGMATIC BREATHING IN TACT (ABLE TO breath on their own)
with varied muscle impairment (intercostal and abdominal)
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| SPINAL SHOCK S/S? | INCREASE BP, INCREASE TEMP BUT EVERYTHING GOES DOWN
BOWEL AND BLADDER DYSFINCTION
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| SPINAL SHOCK IS THE ELECTRICAL _____ FROM THE SPINAL CORD | SILENCE
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| Autonomic Dysreflexia S/S | INCREASE BP
POUNDING HA
DECREASED HR
BLURRED VISON
-DIAPHORITIC
*MEDICAL EMERGENCY
* ABOVE T6
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