TBI
Diagnostic test of choice
CT Head w/o contrast
What keeps the diaphragm alive?
What nerve is impacted by this injury?
C3, 4,5
phrenic nerve
Earliest sign of increased ICP
Change in LOC
•Restlessness (without apparent cause)
•Confusion
•Increased drowsiness
•Agitation
•Slowing of speech
•Delay in response to verbal stimuli
What is another name for Antidiuretic hormone
vasopressin
What must be used when giving mannitol?
Why
Filter needs or filter tubing - crystals
Which TBI complication is identified post portem
Concussion- CTE
When does spinal shock occur? How does it present?
Immediately after the injury
- flaccid paralysis
Where is the EVD Leveled?
tragus of the ear
Where is ADH produced/ where is it stored?
●Produced in hypothalamus
●Stored in the posterior pituitary gland
BONUS (100)
Why does it release from the posterior pituitary?
●Released primarily in response to elevations in serum osmolality and secondarily in reaction to hypovolemia or hypotension
SCI - WHat is the correct maneuver used to open the airway
Jaw thrust
Two hallmark signs of basilar skull fracture
Raccoon eyes (subconjunctival and periorbital ecchymosis)
¡Battle sign (postauricular ecchymosis over mastoid process)
BONUS: (+100) What do we do if a suspected CSF escapes- explain
Describes s/s of Guillain Barre (3 big ones)
+50 for each other besides the big 3
Four others are listed!!
1. SYMMETRICAL ASCENDING motor weakness or paralysis
2. Resp - Neuromuscular respiratory failure (nerves that innervate the diaphragm)
•Changes in vital capacity and negative inspiratory force are assessed
3. Autonomic dysfunction/cardiovascular instability - tachycardia, bradycardia, hypertension (Vagus Nerve)
•Dysphagia (glossopharyngeal & vagus nerves)
•Difficulty with facial movement (trigeminal nerve)
•Double vision or difficulty with movement of the eye (optic nerve)
•Unable to control bowel or bladder (paralytic ileus or urinary retention)
Name three cardinal signs of brain death
1. coma
2. Absence of brain stem reflexes - list
3. apnea - list
BONUS: (100) How many physician notes are required to pronounce brain dead legally?
Central (neurogenic) DI (ADH deficiency) is caused by damage to the hypothalamic-hypophyseal system- list 4 ways this damage can occur.
Head trauma (IICP)
Brain infection
Pituitary tumor
Neurosurgery
What safety measures must be taken before taking a patient to CT scan with an EVD?
Clamp the drain!!
Epidural vs Subdural hematoma
Name 4 differences
1. EDH: arterial bleed/ SDH Venous
2. EDH- talk and die phenomenon, SDH- can be acute/ subacute
3. EDH- complication - UNCAL HERNIATION
4. Visual differences- EDH- grapefruit (protruding) , SDH - crescent moon (diffuse)
Neurogenic shock
It is most common above with injuries above __
Describe patho and how the pt presents
above T6
Results from injury to descending sympathetic pathways in the spinal cord – loss/suppression of sympathetic tone & vasoconstrictor response below the level of injury
Massive vasodilation -> blood pooling in vessels -> tissue hypoperfusion -->impaired cellular metabolism.
S/S explained:
•Decreased blood pressure results from massive peripheral vasodilation
•Decreased heart rate is caused by inhibition of the baroreceptor response and unopposed parasympathetic control of the heart
•Hypothermia develops from uncontrolled peripheral heat loss
Warm, dry skin occurs as a consequence of blood pooling in the extremities and loss of vasomotor control in the skin's surface vessels, which control heat loss.
Normal range for ICP?
What is CPP
how is it calculated
what is the normal range?
ICP: 0-15
CPP: Cerebral perfusion Pressure
CPP is calculated as: MAP − ICP = CPP.
Normal 70-100
SIADH- What do labs look like?
Serum Na _____
Serum Osmolality _____
Urine Osmolality _____
Urine Specific Gravity _____
When do complications occur with SIADH?
What are the complications?
When Na is <120
confusion, seizures, dec. LOC, cerebral edema, coma, death
Name the different types of medical and surgical management - must describe
What is..
1 Mannitol
2. 3%
3. Sedatives
4. EVD/Bolt
5. Craniotomy
6. Craniectomy
BONUS (300): Explain the patho behind the cushions triad.
Autonomic Dysreflexia
Caused by: with injury at or above ___
S/S?
Treatment: **first thing to do
T6
Severe throbbing headache, HTN, Bradycardia, flushing/diaphoresis above injury, pallor below injury
Treatment: raise HOB!!
alleviate noxious stimuli (full bladder, fecal impaction, restrictive clothing), may also give antihypertensives if BP remains elevated
What are activities to avoid that can increase ICP
coughing
oral care
suctioning
turning
vomiting
compression of jugular veins
high levels of PEEP on the vent
List and describe treatment for DI & SIADH
DI: replace fluids (hypotonic sol – be mindful of cerebral edema), Desmopressin (DDAVP)
SIADH: restrict fluids (<1000 mL/day), hypertonic solution (give slowly!), diuretics, Conivaptan (Vaprisol), HOB flat
How do you treat nueurogenic shock?
What do you need to be careful about?
Fluid overload