Peds Neuro fnxn

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Peds Neuro fnxn
2012-12-01 12:44:09

Neurologic function
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  1. What are some terms for LOC?
    • Confused – lacks ability to think clearly and rapidly
    • Disoriented – lacks ability to recognize place or person
    • Lethargic – awakens easily but exhibits limited responsiveness
    • Obtunded – sleeps and, once aroused, has limited interaction with environment
    • Stupor – requires stimulation to arouse
    • Coma – vigorous stimulation produces no response 
  2. What are most deaths related to ICP caused by?
    Increased pressure to the brain stem!
  3. What is Cushing's Triad and what does it mean?
    • Indicative of ^ ICP
    • Consists of: 
    • --^ SBP
    • --bradycardia
    • --changes in RR and pattern
    • (LOC may also be affected)
  4. What are some SnSs of ^ICP in infants?
    • Irritability/restlessness, poorfeeding
    • High-pitched cry, difficult to soothe
    • Fontanels: tense, bulging
    • Cranial sutures: separated/split = Increased OFC
    • Eyes: “setting-sun” sign
    • Scalp veins: distended
    • Increased or decreased response to pain 
  5. What are some SnSs of ^ICP in children?
    • Headache
    • Altered LOC
    • Nausea and vomiting (especially in the morning, then fine for the rest of the day--> EMERGENCY!)
    • Seizures
    • Diplopia, blurred vision
    • Mood swings 
  6. What are some behavioral SnSs of ^ICP?
    • Irritability, restlessness
    • Complains to fatigue/somnolence/drowsiness-->decreased activity. 
    • Inability to follow commands, memory loss 
  7. What are some late SnSs of ^ICP?
    • • Severely Decreased LOC
    • • Decreased motor response to command
    • • Decreased sensory response to painful stimuli
    • • Alterations in pupil size and reactivity
    • • Papilledema (swelling of optic disc)
    • • Decerebrate or decorticate posturing
    • • Cheyne-Stokes respirations (infrequent, irratic breathing-->impending death)
  8. What are some examples of posturing associated with ^ICP?
  9. What is the GLASCOW scale?
    • LOC metric
    • 15 = best score
    • 3 = worst (even dead pts will score 3)
    • Consists of best:
    • --verbal
    • --motor
    • --eyes
  10. What can you do for a pt with ^ICP?
    • Don't do anything that will futher ^ICP, ie...
    • --turn down lights
    • --keep volumes down
    • --HOB elevated
    • --Tx pain
    • --v cough
    • --only suction to maintain airway
  11. What is Hydrocephalus and what can you do about it?
    • Imbalance between the production and absorption of CSF.
    • Tx with shunt to abd or heart. 
  12. What are the 3 major causes of childhood head trauma?
    • Falls
    • MV crash
    • Bike accidents
    • (damage is typically caused by rapid acceloration/deceloration) 
  13. What is trauma caused by initial impact?
  14. Which is more dangerous: Subdural or epidural hematoma?
    • Epidural: faster bleeding and faster ^ICP--> death quicker. 
    • Following injury, child will have brief period of lucidity then prodeed to rapidly lost LOC. 
  15. What does SCIWORA?
    • Spinal Cord Injury Without Radiologic Abnormality
    • In infants, usually caused by shaking. 
    • In older kids, MV trauma, falls, dives, or violence.
    • Tx with immobilization and steroids
  16. What is the most common neuro dysfunction on children?
  17. What is the difference between primary and secondary szr?
  18. What are some possible etiologies of szr?
    • febrile
    • ^ICP for any reason
    • Toxins
    • Electrolyte imbalances
    • Hyperbilirubinemia
    • Birth injury/congenital defects
    • Acute nfxn in late infancy/early childhood.
    • 50% or idiopathic. 
  19. What is a febrile szr?
    • Usually at temps >38.8C (102F)
    • Occures as temp rises, not after
    • Almost always has no lasting neuro consequences
    • Rare after 5 yrs.
    • Tx by:
    • No tepid bath!
    • Antipyretics
    • Call 911 if longer than 5 min
    • Protect child from trauma during szr. 
  20. What is Status Epilepticus?
    • Szr lasting more than 30 minutes continuous or in episodes without regaining normal LOC. 
    • Tx:
    • Maintain airway
    • Get IV access
    • Rx with Diastat, IV Diazepam/Lorzepam, or Versed.
  21. What are some other common anticonvusants?