TBI
At what pressure is ICP considered elevated
15mmHg
Hyponatremia, volume contraction, high urine Na
Cerebral salt wasting
Name 3 complications after SAH
rebleeding, cerebral vasospasm, increased ICP, seizures, neurogenic pulmonary edema, cardiac dysrhythmias and EKG changes, Hyponatremia (CSW, SIADH), obstructive hydrocephalus
Name 5 things to avoid to prevent secondary injury after TBI
hypoxia, hypotension, Hypercarbia, Acidosis, Hypo or Hyperglycemia, Hyperthermia
Name one of the top three best selling albums of all time
Michael Jackson – Thriller
AC/DC - Back in Black
Pink Floyd – Dark side of the moon
Name 4 ways to lower ICP
Hyperventilation, Mannitol (Osmotic diuresis), lasix, increased sedation / anesthesia , elevate HOB, Hypertonic saline, barbiturate coma, drain (EVD) (steroids do not improve outcome of lower ICP in severe TBI)
General vasoconstriction, lack of central nervous modulation, HTN, upper body flushing, bradycardia
Autonomic Hyperreflexia
What helps distinguish between SIADH and CSW on clinical evaluation
Volume status – SIADH – hypervolemia, CSW - hypovolemia
What is the major source of blood supply to the spinal cord
anterior spinal artery (supplies 75%)
Name the lead singer of Queen and how he died
Freddy Mercury, AIDS
What is the recommended target PaCO2 when using hyperventilation for ICP management
Between 30-35 mm Hg
Hyponatremia, elevated urine osmolality/concentrated urine, often hypervolemic
Name a classification system for grading SAH
Hunt Hess classification- 5 grades based on signs/sxs,
Fisher Scale based on CT findings
What is cushings triad
In response to ICP there is
- reflex increase in MAP
- reflex decrease in HR
- irregular respiration
Who married Justin Bieber
Hailey Baldwin
In the setting of TBI, which is lost – autoregulation of CBF or CO2 responsiveness?
autoregulation is lost; you still use hyperventilation
Occurs when Hyponatremia is corrected too rapidly
Central Pontine Myelinosis
A patient on POD 3 for aneurysm repair has a decline in neuro exam and vasospasm is suspected, what two tests/procedures can be used to diagnose vasospasm
transcranial dopplers, Angiography
Discuss the brain death clinical exam (there are three main components)
Unresponsive Coma, no CN reflexes, Apnea
In which state was Madonna born?
Michigan
What drug(s)would you use to induce an emergent craniotomy in a patient with AMS and concern for raised ICP and why?
I would use etomidate (and Rocuronium) as etomidate will avoid cardiovascular depression that would result in hypotension and reduced cerebral perfusion pressure. – If you say you are going to use propofol then explain that you will support blood pressure as needed. Its ok to use Sux. The benefits of rapid onset outweigh the risks of transient increase in ICP. Blunt the sympathetic response to intubation with fentanyl / lidocaine
Explain intracerebral steal syndrome
Ischemic vessels are already max dilated, if CBF increases due to CO2 rising, normal vessels dilate and steal from the ischemic area
A patient with SAH and raised ICP presents for surgery, they have an expected difficult airway. How will you induce / intubate
– If you say fiberoptic, you need to discuss sedation and avoiding hypertension, increasing ICP
Discuss your concerns with sitting position for posterior fossa craniotomy
Venous Air embolism – with paradoxical air embolism if PFO present, Decreased venous return / Hypotension– leading to decreased cardiac output and cerebral perfusion pressure, arterial line transducer should be at the level of the head, hyperflexion of the neck – jugular venous obstruction, ETT migration, compression of spinal cord leading to quadriplegia
Two Songs are tied for the most weeks as number one on Billboards Hot 100. Name one of them
One Sweet Day (Mariah Carey and Boyz to Men 1995)
Despacito (Luid FOnsi and Daddy Yankee ft JB 2017)
Both were number 1 for 16 weeks