FPC NEUROLOGICAL EMERGENCIES
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What is MAP?
Mean Arterial Pressure
What is the formula used to determine MAP?
What is CPP?
Cerebral Perfusion Pressure
What is the formula used to find CPP?
MAP - ICP
What is the normal CPP range?
60 - 80 mmHg
What is the normal MAP range?
80 - 100 mmHg
What is your normal ICP range?
0 - 10 mmHg
ICP greater than what has a high mortality?
Where is ICP transducer placed?
Foramen of Monro (level of the ear)
What is posturing associated with?
- Brainstem herniation
- Decorticate "to the core"
What are the 3 legs of Cushings Triad and what does it indicate?
- ↑ Pulse Pressure (Systolic & Diastolic values will be far apart)
What breathing pattern is associated with increased ICP?
What is your treatment for brain stem herniation?
- Paralyze (RSI)
- Intubate (RSI)
- Hyperventilate (Goal PaCO2 30-35 mmHg)
- Mannitol (1g/kv IV bolus over 5 min)
- Hypertonic Saline (Give slowly)
What do you treat seizures from brainstem herniation with?
- Phenytoin (Dilantin) 1G loading dose infused at 50mg/min
Can Lasixs be used in the setting of brainstem herniation?
Yes. After Mannitol. Will not work as well.
Does hyperglycemia make brain injuries better or worse?
Describe a Diastatic Fracture.
Fracture along the suture line
Describe Linear Fracture.
Fracture that extends towards the base of the skull.
Describe Linear Stellate Fracture.
Spider Web appearance
What can a depressed skull fracture lead to?
What type of injuries are the leading cause of death in trauma patients?
What is the GCS injury scale?
- Minor 13 - 15
- Moderate 9 - 12
- Severe < 8
Define a hypertensive crisis/emergency.
- Visual Changes
What do we use to lower a patient's BP?
- Nitroprusside (Nipride)
Describe an Epideral Hematoma.
- Arterial Bleed
- Vessel damaged is the Middle Meningeal Artery (MMA)
Describe the patient's LOC while suffering from a Epidural Hematoma.
- unconscious for a minute
- wake up
- then goes unconscious 30 minutes later
What pattern of respirations would you expect in a Epidural Hematoma patient?
Is a subarachnoid hemorrhage life threatening? What is a common complaint?
- "Worst headache of my life"
What is our treatment for a SAH?
- Keep SBP below 140 mmHg
Patients with elevated BP should be treated with Nitroprusside (Nipride)
Where is the T4 dermatome?
Where are the T10 dermatomes?
C3, C4, C5 intervate what?
What is Autonomic Dysreflexia?
What is the treatment?
- In a paralyzed/spinal cord injury pt bladder become distended
- Insert Foley catheter slowly
What is an important physical finding on spinal cord injuries?
- Babinski's Sign (reflex)
- When foot is stroked big toe goes up other toes fan out
What is a Brown Sequard Lesion?
- Same side motor & vibratory sense loss below level of injury
- Opposite side pain & temp loss
Describe Central Cord Injury.
- Motor weakness in upper extremities more than lower.
- They can walk to you but can't shake your hand.
Describe Anterior Cord Syndrome.
Loss of pain & temperature sensation everywhere below the level of injury
What do we trat Spinal shock with?
What are the signs of Distributive shock?
What is the treatment?
- Warm red skin
- No tacycardia
- IV fluids & vasoressors
What is the triad of nuchal rigidity (Meningitis)?
- neck stiffness
What is Brudzinki's Sign?
Involuntary lifting of leg when lifting a pt's head while laying flat
What is Kernig's Sign
What personal protective measures for Meningitis?
What do you treat Herpes Simplex Encephalitis with?
Define Status Epilepticus.
- Seizure lasting longer than 30 min or
- multiple seizures without regaining continuous for greater than 30 min
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