Medications
To treat autonomic dysreflexia, emergency treatment consists of administering ___________ to reduce __________.
Hydralizine/nitrates/nifedipine; blood pressure
What are the 3 components of ICP and approximately what percentage does each make up?
1. Brain (80%)
2. Cerebral Spinal Fluid (10%)
3. Blood (10%)
What 3 signs/symptoms signify Cushing's Triad?
Systolic hypertension, bradycardia, widening pulse pressure
What type of drain is used to decrease ICP above 20 mmHg and when is it indicated?
Ventriculostomy Drain; excess CSF, GCS of 8 or less, abnormal imaging (MRI/CT)
Name causes of autonomic dysreflexia
Bladder or bowel distention, excessive rectal stimulation, uterine contraction stimulation, bladder stones, painful pressure
What types of medications and fluids/solution can be used to decrease ICP?
Diuretics (Mannitol), Anticonvulsants, and Hypertonic 3% saline solution
Cerebral Perfusion Pressure (CPP) is maintained by a process know as what? In order to maintain constant cerbral blood flow (CBF), a mean arterial pressure (MAP) should be what?
Autoregulation; 70-150 mmHg
What sign/symptom is the outlier when it comes to neurogenic shock compared to all other types of shock?
Bradycardia (low heart rates)
Identify types of treatment for hemorrhagic strokes
Surgery, ventriculostomy placement, craniotomy
What type of fracture is associated with epidural hematomas, and how would the patient present?
Skull fracture; brief LOC, then alert and then onset of severe headache
What is the last resort treatment for increased ICP and how does it work?
Barbiturate Coma; decreases cerebral metabolism and oxygen requirement
What is a normal ICP and when does intracranial hypertension occur?
5-15 mmHg; 20 mmHg
What are examples of later signs of increased ICP?
Altered breathing patterns, posturing, diminished brain stem reflexes, Cushing's Triad (Emergency)
What diagnostic test/procedure should not be done on a patient with suspected increased ICP?
Lumbar Puncture
What are causes of hemorrhagic stroke?
Arterial-venous malformations, cerebral aneurysms, untreated hypertension (>200/100)
vasospasms from ruptured blood vessels (subarachnoid hemorrhage)
Altered Level of Consciousness (LOC)
What are examples of earlier signs of increased ICP?
Alternation in LOC, Unequal pupil size, decreased pupillary reaction time (sluggish), projectile vomiting, stiff neck, photosensitivity, headache
What is the proper positioning for a patient with increased ICP?
HOB at 30 degrees and a neutral head, neck, and hip position
How can you identify if fluid is CSF?
Glucose greater than 30 mg/dL; Halo sign
What are the two most effective types of treatment for Guillan Barre Syndrome?
Plasmapheresis (PE) and IV immunoglobulin (IVIG)
When ICP falls quickly, it is indicative of _______?
Herniation Syndrome
You assess a patient with a spinal trauma injury and find that they are having difficulty breathing. What level of spinal injury do you suspect the patient has?
C1-C5
What are the goals for pCO2, pO2, and PEEP when managing increased ICP?
pCO2 should be 35+/-2, pO2 greater than 80mmHg, PEEP <20
What ABGs cause cerebrovascular dilation vs. cerebrovascular constriction?
Acidosis=dilation, alkalosis=constriction