Ice Cold Lifesavers
Who approaches family about organ donation?
STA Representative
What is the target temperature needed prior to performing a brain death exam?
>36'C, normothermia
What is the first action when your patient has acute neuro changes?
Call RRT
What color is bone on a CT?
White
What does BEFAST stand for?
balance, eyes (vision), face, arms, speech & time
What is the criteria to call STA
Ventilator dependent:
absence of 1 or more brainstem reflexes, anticipated permanent critical care needs, or planned goals of care/end-of-life conversations.
What is the GCS MOTOR score needed to declare a patient brain dead?
1 (anything else means the pt is not brain dead)
1 = no response, 2 = extensor posturing, 3 = flexor posturing, 4 = withdrawal, 5 = localizes, 6 = obeys commands
Who initiates a code stroke?
RRT nurse
What color is the CSF in a head CT?
black, dark
What are the 3 layers of the meninges from inside out.
pia mater, arachnoid, dura mater
How many lives can be saved or improved through donation?
8 lives, 75 through tissue donation
If unable to complete a portion of the clinical exam or the apnea test, what are the ancillary tests acceptable to use?
a. Transcranial dopplers (TCDs)
b. Nuclear blood flow scan
c. Catheter angiogram
What exam quantifies neurological deficits in a standardized manner across examiners?
NIHSS
What is the CT hallmark of a subarachnoid hemorrhage?
hanging chicken or star sign in the cisterns
Name a medication to reduce cerebral edema
Mannitol, 3% hypertonic saline gtt, 23% hypertonic saline
Who is responsible for patient orders for DCD (donation after cardiac death) and death by neurologic criteria?
DCD - UTSW hospital team, death by neurologic criteria - STA team
What are the brainstem reflexes checked in a formal determination of death by neurologic criteria?
a. Pupillary light reflex
b. Corneal reflex
c. Oculocephalic reflex (aka Doll’s eyes)
d. Vestibulo-ocular reflex (aka cold calorics)
e. Cough AND gag reflex (need both, even though gag is unreliable)
The time frame from which a patient qualifies for TNK administration
What is 4.5 hours from LKW
Why are x-rays called x-rays?
The inventor published his findings without naming the x in x-ray
Where is CSF produced?
choroid plexus
Number of people in the US waiting for a transplant
approximately 100,000
How long do we observe a patient during an apnea test?
8 minutes (minimum)
Dizziness, vomiting, diplopia, and ataxia are the s/s of this stroke location
What is posterior cerebral circulation - cerebellar, posterior cerebral artery
Who discovered the X-ray?
Wilhelm Conrad Rontgen
Name 4 of the 12 cranial nerves
olfactory, optic, oculomotor, trochlear, abducens, trigeminal, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal