Pinky and the Brain
By a year and a half these close, leaving a rigid skull incapable of expanding in response to increased ICP
What are fontanels?
*anterior closes by 18 months and posterior by 2 months
Normal ICP should be less than this
What is 20 mmHG?
This is the most common neurological emergency in children and has an overall mortality of 10 to 15 percent; the mortality rate in young children is 3 percent.
What is status epilepticus?
An injury to the head that causes the brain to “shake” inside the skull
What is a concussion?
One of the most common CNS infections in pediatrics, causing inflammation of the membranes covering the brain, symptoms include irritability, headache, nuchal rigidity, and purpuric/petechial rashes.
What is meningitis?
The excess accumulation of cerebrospinal fluid (CSF), caused by an imbalance in the production and/or absorption of CSF in the ventricles
What is hydrocephalus?
*different types? (obstructive/non-communicating, communicating, increased production)
These are s/s of increased ICP in infants vs older kids (list 3 for each)
infants: A full or bulging fontanel, split sutures; Distended scalp veins; Increased head size, jumping curves on head growth charts; Increased irritability; Sleepiness (premature infant may have increased incidence of apnea and bradycardia); Less interest in eating; Vomiting; Not meeting milestones or regressing developmentally; Sunset eyes
Older kids: Headache, Vomiting, Changes in personality, behavior or school performance, irritability and/or lethargy, advancing to coma, papilledema
if intubated: Change in GCS, pupillary response, VS, ICP waveform, posturing/abnormal reflexes, CPP <40
*Cushings triad is a LATE sign
Safety considerations and assessments to make for your patient during a seizure (generalized tonic/clonic, status, etc)
what are: padded bed rails; evaluate for a patient airway/effective breathing, side-lying with head extended, having suction ready, don't place anything in their mouth; provide 100% oxygen by NC or BVM if impaired breathing- **may not be able to bag during a seizure; assess for bradycardia and hypotension; check a CBG, obtain and IV and labs; VNS magnet, prepare rescue meds (IN vs IV vs rectal)
These considerations are important for a patient with a bone flap
What is having a helmet on when HOB >30 degrees or patient is out of bed, don’t lay patient on the side of the missing bone flap, pad the bed rails
3-4 Nurse driven methods to help manage delirium
A flexible tube that internally drains excess CSF from the brain's ventricles, is the most common treatment for hydrocephalus
What is a ventriculo-peritoneal shunt (VPS)?
This device is considered the gold standard and most accurate way to measure whole brain pressure, usually placed in a burr hole at Kocher's point
What is an External Ventricular Device or EVD?
Seizures resistant to medical interventions including medications, ketogenic diet, vagal nerve stimulators and localized radiosurgical (gamma knife) interventions. Surgical intervention may include a hemispherectomy, which can greatly improve quality of life
What are intractable seizures?
This condition causes premature closure of the sutures of the skull, which can cause limitations on brain growth and cosmetic disfigurement
What is craniosynostosis?
70% of brain tumors in children occur in this area of the brain, complications include dysphagia, respiratory failure, balance disturbances and emotional lability
What is the Posterior Fossa?
A procedure in which a small opening (approximately 3 mm hole) is made in the floor of the third ventricle with an endoscope. This opening allows the CSF to flow out of the blocked ventricle and into the basal cisterns of the brain for absorption.
What is an Endoscopic Third Ventriculostomy (ETV)?
The gradient needed to keep blood moving throughout the brain, when ICP increases this decreases
What is Cerebral Perfusion Pressure (CPP)?
Often referred to as dissociative convulsions or conversion disorder, these have a quick recovery and no post ictal confusion or fatigue, usually in older children
What are Psychogenic Non-Epileptic Seizures (PNES) or pseudo-seizures?
A collection of blood between the brain and the dura mater. Bleeding is usually venous in origin and can develop over hours (acute) or days to weeks (chronic). Often seen in cases of abusive head trauma.
What is a subdural hematoma?
Surgeries or TBI near the pituitary can cause this, resulting from a deficiency of vasopressin
What is Diabetes Insipidus (DI)?
Alterations in one of these three components in the skull will cause increased ICP
What is blood, brain, CSF?
A method of reducing increased ICP is the use of this therapy, which helps to reduce ICP by decreasing the fluid volume in the cranial vault
What are hyperosmolar therapies?
Mannitol and Hypertonic Saline
What are ativan, midazolam or diazepam?
This global brain injury is caused by acceleration and/or deceleration forces, resulting in shearing (or tearing) of the axons in the white matter and can cause widespread damage, edema and ischemia.
What is Diffuse Axonal Injury (DAI)?
Surgical approach includes through the nose, mouth or gums; common complications include CSF rhinorrhea, infection (meningitis), electrolyte imbalance and possibly DI
What is transsphenoidal?
*know how to test for a CSF leak?*