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38 Cards in this Set
- Front
- Back
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What are 4 reasons for altered states of consciousness?
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1 - bilateral cerebrocortical disease
2 - damage to ARAS 3 - diffuse brain disease 4 - abnormalities of sleep centers |
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Why does bilateral cerebrocortical disease occur?
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-traumatic cerebral edema
- toxic and metabolic encephalopathies -inborn errors of metabolism |
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What does damage to ARAS occur?
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-copression
-infiltration or destruction of brain tissue |
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What is ICP generated by?
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1 - volumes of:
-brain tissue (80%) -Blood (10%) CSF (10%) 2 - inelastic skull |
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What is normal ICP?
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5-10 mmHg
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At what point is ICP detremental?
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>20-25 mmHg
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What is the common denominator for clinical alterations in consciousness/neurologic deterioration?
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increased ICP
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How does the body adapt to increased ICP?
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-displacement of CSF outside the cranial vault
-increase in CSF absorption |
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What does CBF =
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MaBP - ICP
-as as ICP increases, CBF decreases |
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As ICP increases, CBF decreases, causing what type of changes in the body?
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-ischemic/hypoxic injury
-excitotoxicity/inflammation -cell death |
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What scale do you use to evaluate a patient with altered consciousness?
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-small animal coma scale
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What things are evaluated on the SACS?
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1 - state of consciousness
2 - abnormalities of head or body posture 3 - motor function 4 - brainstem reflexes |
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What does a low SACS mean?
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more severe dysfunction, but a single sore is not definitive - must look more at trends
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What is a decerebellate posture?
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rigid extension of the head and neck with flexion of the pelvic limbs
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What is a decerebrate posture?
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extension of head and neck with extension of both sets of limbs
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Is it a better prognosis for both pupils to be constricted or dialated?
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constricted
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What are the signs of a midbrain compression and transterntorial hernation?
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-stupor to coma
-mydriasis with no PLR -decerebrate posture -ventrolateral strabismus |
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What are the signs seen with an acute hernation of the brain into the foramen magnum?
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-stupor to coma
-pontomeduallry carnail nerve deficits -neurogenic hypoventilation -death |
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What are the lesions associated with a TBI?
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-Primary - direct tissue damage
-Secondary - targets of medical treatments |
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What are the 5 things to consider when doing the initial assessment of a TBI?
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1 - emergency ABCs
2 - systemic injury survery 3 - SACS score 4 - minimum data base 5 - BP |
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With what SACS score would you recommend diagnostic imaging with a TBI?
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8 or below
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What is the number one goal when managing intracranial hypertension?
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-optimization of CARS
-Cardiovascular and Respiratory System |
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What factors do you want to esp. look at when manageing intracranial hypertension?
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- normotension
-normovolemia -normocapnia -HYPERoxygenation -fluids |
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What is goal number 2 when managing intracranial hypertension?
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reduce ICP
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What are physical methods for reducing ICP?
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- elevate head
- induce hypothermia (84-94) -avoid jugular compression -decompressive craniectomy and durotomy -CSF diversion (ventriculostomy, ventriculoperitoneal shunt, CSF tap) |
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What are diuretics to help decrease ICP?
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1- diuretics
- mannitol (positive rheologic agent, free radical scavenger) -furosemide (prevents rebound ICP) |
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What durgs will help decrease ICP?
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-barbituate comma (PENTObarb)
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What are disadvantages to using pentobarb for decreasing ICP?
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-hypoventilation
-hypotension -complicates clinical SACS |
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Should you use corticosteroids to decrease ICP?
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NO - never
-exacerbates lactic acidosis |
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When should diuretics be used to treat ICP?
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1 - CARS goals achieved
2 - SACS score going down despite therapy 3 - SACS score static for greater than 24 hours with normal CARS parameters |
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When should craniectomy/craniotomy be considered for intracranial hypertension?
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1 - qualifies surgeon present
2 - exam and or imaging ID a lesion that can be surgerized 3 - SACS score going down despite other therapy |
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What type of lesions are emenable to surgery?
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-focal hematoma
-depressed skull fracture -penetrating missile -open, contaminated wound |
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What is the 3rd goal for managing a TBI?
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systemic supportive care
-CNS recovery -hygiene (corneal lubrication, bladder expression) -PT -fluid, acid-base and nutritional support -analgesia |
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What things should be monitored daily in a patient with a TBI?
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- MaBP
-ECG -Blood gluocse - urine output -SACS score -BW |
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When are residual motor and sensory deficits more common?
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with brain stem injury
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When do most forebrain injuries improve>
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1-2 weeks with unassisted ambulation in 4 weeks
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Dogs with a SACS less than 8 after 48 hours have what type of chance of survival?
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50%
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What areas of the brain when injured have a better prognsosi?
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cerebellar or forebrain
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