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Flight Paramedic Certification > Neurological Emergencies > Flashcards

Neurological Emergencies Flashcards

1
Q

Define Pia Mater

A

Thin cerebral cortex cover, Inner most layer

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2
Q

Subarachnoid space

A

Located between Arachnoid and Pia Mater. Contains CSF

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3
Q

Define Dura Mater

A

Tough outer covering. (2 layers, outer covering adhesed to skull.)

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4
Q

Epidural space

A

Potential space between skull and dura mater. (requires high pressure to create bleed, usually arterial and eye shaped on CT scan)

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5
Q

Subdural space

A

Potential space between dura mater and the arachnoid

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6
Q

Normal ICP

A

0-10 mmHg

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7
Q

Transducer location for monitoring ICP

A

Even with the Foramen of Munro (even with ear canal)

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8
Q

Normal CPP

A

> 60 mmHg

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9
Q

CPP formula

A

CPP = MAP - ICP

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10
Q

MAP formula

A

MAP = DBP + 1/3 pulse pressure

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11
Q

Pulse pressure formula

A

SBP - DBP

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12
Q

S/S of increased ICP

A 
Change in LOC, pupil size and reaction
Abnormal motor response
Decorticate posturing
Decerebrate posturing
Cushing's Triad
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13
Q

What is Decorticate posturing?

A

Adduction of arms towards core.

Indicates damage above cerebellum and brainstem

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14
Q

What is Decerebrate posturing?

A

Extension and hyperpronation of arms.

Indicates damage to brainstem or compression of thalamus and brainstem

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15
Q

Cushing’s Triad

A

Hypertension
Bradycardia
Respiratory changes
(Widening pulse pressure)

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16
Q

Treatment of ICP

A

Position patient (eyes forward with c-collar)
Limit noxious stimuli (suction, noise, pressure change, invasive procedures)
Maintain euvolemia, normothermia, electrolytes
Sedation (benzos, Propofol)
Analgesia (opioids, fentanyl)
NMBA (non-depolarizing)

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17
Q

Subdural Hematoma

A

Blood between dura and arachnoid layer (usually venous)

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18
Q

3 types of subdural hematoma

A 
Acute = symptomatic within 24 hours
Subacute = symptomatic within 2-10 days
Chronic = symptomatic after 2 weeks
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19
Q

Subdural hematoma in different age groups

A

Elderly = larger subdurals with slowly developing symptoms due to cerebral atrophy

Younger = Rapid onset of symptoms with marked increased ICP

Pediatric = Typically occur <18 months, look for bulging fontanelle and retinal hemorrhage

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20
Q

Epidural Hematoma

A

Bleeding between skull and dura mater (usually arterial)

Laceration of the middle meningeal artery in the temporal lobe

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21
Q

Classical symptom of Epidural hematoma

A

Transient loss of consciousness followed by lucid period

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22
Q

Define Subarachnoid Hemorrhage

A

Bleeding between arachnoid membrane and pia mater.

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23
Q

Common causes of subarachnoid hemorrhage

A 
#1 - Trauma
#2 - Berri aneurysm (rupture due to HTN)
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24
Q

Classical symptoms of subarachnoid hemorrhage

A

Worst headache of my life
N/V, stiff neck, vision disturbances, altered LOC
(commonly confused with meningitis, do not do lumbar puncture)

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25
Q

Define Intracerebral hemorrhage

A

Hemorrhage in the brain parenchyma
Produced from shearing and tensile forces
Frequently occurs in the white matter of the frontal and temporal regions

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26
Q

Define Intraventricular hemorrhage

A

Bleeding in the ventricles due to trauma
Results from shearing forces
Greatly increased mortality rate

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27
Q

Define mild concussion

A

Short duration of retrograde amnesia

28
Q

Define classic concussion

A

Brief LOC, retrograde and post-traumatic amnesia

29
Q

Define Diffuse Axonal Injury (DAI)

A

Usually coma
Increased ICP
Profound neuro, psych, personality deficits

30
Q

Three classifications of stroke

A

Emboli
Hemorrhagic
Thrombotic

31
Q

Stroke treatment

A

Thrombolytic therapy within 3 hours of onset (clot only)

Maximize cerebral blood flow, control ICP, supportive care

32
Q

Linear fracture

A

A line that extends towards base of skull

33
Q

Linear Stellate fracture

A

Multiple fractures that radiate from the compressed area

34
Q

Diastatic fracture

A

Separation of the bones at a suture line

35
Q

Depressed skull fracture

A

May be closed or open

36
Q

Define basilar skull fracture

A

Fracture at base of skull

37
Q

S/S of basilar skull fracture

A

Battle’s sign (bruising behind ears - late)
Periorbital ecchymosis (Raccoon eyes - late)
Otorrhea - bleeding from ear with CSF leak (early or late)
Rhinorrhea - bleeding from nose with CSF leak (early or late)

38
Q

Skull fracture complications

A

Pneumocephalus (Boyle’s law can increase)

Infections, hematoma, nerve damage, palsies

39
Q

Lefort I fracture

A

Fracture of maxillae

40
Q

Lefort II fracture

A

Fracture of nose and maxillae

41
Q

Lefort III fracture

A

Fracture of midorbit, nose, and maxillae

42
Q

Presentation of Lefort fractures

A

Epistaxis
Trismus
Rhinorrhea
“Floating facial regions”

43
Q

Treatment of Lefort fractures

A

Secure airway

Avoid accessing nose (ETT, NG, NPA)

44
Q

Neurogenic shock

A

Flaccid paralysis immediately or shortly after injury

Parasympathetic dominance below lesion

45
Q

S/S of neurogenic shock

A

Hypotension
Warm red skin below injury
Absence of tachycardia

46
Q

Anterior cord injury S/S

A

Complete motor, pain, and temperature loss below the lesion

47
Q

Brown-Sequard injury S/S

A

Loss of movement on the same side as the cord damage.

Loss of pain, temp, and sensation on opposite side

48
Q

Central cord injury S/S

A

Greater motor weakness in upper extremity than in lower extremity with varying degrees of sensory loss

49
Q

Autonomic dysreflexia S/S

A

Urinary retention, massive increase in sympathetic tone causing HTN, treat with foley

50
Q

Cranial Nerve I

A

Olfactory: Smell

51
Q

Cranial Nerve II

A

Optic: Visual acuity

52
Q

Cranial Nerve III

A

Oculomotor: constricts pupil, opens eyelid

53
Q

Cranial Neve IV

A

Trochlear: look down and outward

54
Q

Cranial Nerve V

A

Trigeminal: forehead, cheek, and chin movement

55
Q

Cranial Nerve VI

A

Abducens: rotate eyeball outward

56
Q

Cranial Nerve VII

A

Facial: smile, close eyelid, facial movement

57
Q

Cranial Nerve VIII

A

Acoustic: hearing and balance

58
Q

Cranial Nerve IX

A

Glossopharyngeal: swallow and gag reflex

59
Q

Cranial Nerve X

A

Vagus: sympathetic / parasympathetic responses - HR, BP, Breathing

60
Q

Cranial Nerve XI

A

Spinal Accesory: shoulder shrug, head turning

61
Q

Cranial Nerve XII

A

Hypoglossal: toungue movement

62
Q

GCS of 13-15 indicates?

A

Minor injury

63
Q

GCS of 9-12 indicates?

A

Moderate injury

64
Q

GCS of <8

A

Severe injury

65
Q

TPA administration

A

IV TPA if <3 hours
Intrarterial TPA <6 hours
MERCI if 8-12 hours (roto-rooter)

Flight Paramedic Certification (15 decks)

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