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Flashcards in Neurological System Deck (45)
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1
Q

What is the best continuous sedative drip for intubated neuro patients

A

Propofol ( diprivan)

2
Q

What part of the neuro exam is the best indicator of neurological deterioration

A

Changes in LOC

3
Q

What are late signs of deteriorating neurological status

A

Fixed and dilated pupils

Decerebrate posturing

4
Q

Cranial nerve 3

A

Oculomotor
EOM pupil constriction
Raises lowers eyelid

5
Q

Cranial nerve 4

A

Trochlear
EOM
Down and in

6
Q

Cranial nerve 6

A

Abducens
EOM
Lateral gazes

7
Q

Cranial nerve V

A

Trigeminal

Sensory of face and mastication and corneals

8
Q

Cranial nerve 9

A

Glossopharangeal

Posterior taste buds and innervates pharyngeal sensation

9
Q

Cranial nerve 12

A

Hypoglossal

Tongue movements

10
Q

What is the cerebellar responsible for

A

Gait and posture

11
Q

What does the cerebellar exam consist of

A

Gait and posture
Heel to shin ( drag heel of one foot down the shin of opposite leg looking for uninterrupted contact)
Ataxia ( staggering, unsteady wide gait)
Dysmetria ( inability to control the range of movement in muscle action { past pointing}

12
Q

Where is c4

A

At the clavicle

Innervates the diaphragm

13
Q

Where is t4

A

At the nipple

14
Q

Where is t10

A

At the umbilicus

15
Q

Brain death testing

A

Dolls eyes
+ dolls eye is a good sign ( the eyes moves in the opposite direction the head was turned)
If the reflex is negative severe brain stem damage is indicated

16
Q

Oculovestibular reflex

A

Infusion of ice cold water into the ear canal of a comatose patient
A intact brain stem will turn the eyes outward and downward from affected ear

17
Q

A GCS 8 or less indicates what

A

Comatose

18
Q

A GCS of 3 indicates what

A

Unresponsive

19
Q

Central pain

A

Tells examiner what level the brain is functioning

20
Q

Peripheral pain

A

Tells the examiner what level the cord is functioning

21
Q

What’s normal ICP

A

0-15

22
Q

What is ICP

A

Pressure within the cranial volt

23
Q

What is CCP

A

Cerebral perfusion pressure

24
Q

What is normal CCP

A

60-80

25
Q

How do u calculate CCP

A

MAP-ICP=CCP

26
Q

What drain can calculate ICP

A

EVD

27
Q

What is Cushing triad

A

HTN
Bradycardia
Widened pulse pressure

28
Q

What is criteria for brain death

A
  1. Pupils nonreactive ( usually dilated)
  2. No protective reflexes ( cough, gag, corneals)
  3. No respirations above what the vent provides
  4. Core temp 36 degrees Celsius or above
  5. PACO2 greater than 60
  6. No movement of any kind to central pain
  7. On no sedatives, paralytics, or barbiturates
29
Q

Brain facts

A

Brain is totally dependent on oxygen and glucose for its metabolism
Receives 750 ml/min blood
Recieves 15-20% of resting cardiac output
Brain is supplied by 2 major arteries

30
Q

What is a ischemic stroke

A

Occlusion of a blood vessel

31
Q

What is a hemmorhagic stroke

A

Rupture of a blood vessel

32
Q

What is penumbra

A

Zone of hypoperfused neuronal cells that are unable to function but remain viable
Located around the injury

33
Q

What’s a embolic stroke

A

Clots form elsewhere and travels to brain

Accounts for 15-20% of all ischemic strokes

34
Q

Where’s the origin of a embolic stroke

A

Cardiac origin

A fib, decreased heart valves, infectious endocarditis, cardiomyopathy

35
Q

What’s a thrombotic stroke

A

Atherosclerosis vessels narrow, the plaque may dislodge

TIAs may precede

36
Q

What’s the origin of a thrombotic stroke

A

HTN
Smoking
Diabetes

37
Q

How do you diagnose a stroke

A

A CT to rule out hemmorhage is the gold standard ( should be done within 25 min)
CTA to identify acute vascular occlusion
Perfusion CT shows areas of perfusion and penumbra

38
Q

What’s the gold standard on examining cerebral circulation

A

Angiography

39
Q

What may patients with a intercerebral hemmorhagic present with

A

Lateralized weakness, sensory symptoms, aphasia, visual field cuts
Headaches, vomiting,
Elevated systolic pressure
Coma and / or decreases in LOC

40
Q

What is care of the intercerebral hemmorhage

A

Medical priorities to prevent hematoma expansion
Reverse anti coagulants ( vit k, FFP, Factor VIIa
BP management
Maintain CCP above 60 if monitoring ICP

41
Q

What’s a subarachnoid hemmorhage

A
Presentation of classic  severe headache 
May have loss of consciousness 
Unchallenged rigidity or stiff neck
Photophobic, photophonic
N/V
Focal neurologic deficits
42
Q

How do you diagnose SAH

A
Cerebral angiography do the gold standard 
Non contrast CT
lumbar puncture
MRA
CTA to detect aneurysm
43
Q

What are complications of SAH

A

Cerebral vasospasm

Hydrocephalus

44
Q

What med is riven q4 hr to every SAH patient

A

PO CCB

45
Q

What are strategies for ICP management

A
Bed 30 degrees
Suctioning 
3% NS OR 1.5% NSS if peripheral line 
Osmotic diuretic 
Paralytic, sedation
Temp control, seizure control hypothermia