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244 Cards in this Set
- Front
- Back
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define Seizures
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A seizure is an event of altered brain function as a resalt of abnormal hypersynchronous paroxysmal cortical
neuronal discharge with either motor convulsions, sensory or cognitive dysfunction |
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What metabolic disorders puts you at risk for seizure like activity
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Acidosis
Electrolyte imbalances Hypoglycemia Hypoxia Alcohol or barbiturate withdrawals Drug intoxication |
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Non metabolic causes of seizures
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Infections
Trauma Tumors Vascular diseases Natural reaction to physiologic stressOr transient systemic injury |
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Most common cause of seizures
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Noncompliance with medication regimen
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These classifications of seizures
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Partial
Secondary generalized partial seizures Generalized seizures Status epilepticus |
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Partial seizures are further divided into
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Simple partial
Complex partial |
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Qualities of partial focal seizures
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Involves only a portion of the brain at onset
only one hemisphere Has been activated Divided into simple partial and complex partial |
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Qualities of simple partial seizures
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Consciousness remains intact
Signs and symptoms depend on location of the seizure focusAnd can cause focal motor somatosensoryAutonomic and psychotic Last about 60 seconds the 90 sec |
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qualities of complex partial seizures
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Progresses to another area of the brain
Consciousness is impaired but they did not lose consciousness last 30 seconds to several minutes Maybe preceded by aura Not in control of speech for movement Lips smacking Feels tired and weak after Activity starts in one area of the brain spreads to another |
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Qualities of generalized seizures
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Involve the entire brain at onset
Types include tonic, Clonic, Tonic conic, and atonic Abnormal discharge starts from both sides of the hemisphere at the same time Lots of level of consciousness Altered respiratory pattern |
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Qualities of secondary generalized partial seizures
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Starts from one areaand spreads to the whole brain and can turn into generalized seizures
Simple or complexProgressing to generalizeWith loss of consciousnessAnd motor activity that is often comvulsive |
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types of generalized seizures
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Tonic
Conic Tonic conic Atonic |
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Qualities of absent seizures
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Type of generalized seizure
Abrupt onset No aura Last few secondsTo 30 seconds ends abruptly Also known as petite mall Brief lapses of consciousness without motorAffect |
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Myoclonic seizure qualities
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Sudden
Shocklike contractions confined to face trunk or limbOr to an individual muscle group A.k.a. muscle contraction |
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Qualities of tonic seizures
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Brief less than 60 seconds increased tone in the extensor muscles
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Qualities of clonic seizures
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Consisted of only rhythmic or semi rhythmic contractions of muscle groups without stiffening
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Qualities of Grand mal seizures
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Stiffening followed by generalizing jerking of the muscles
Level of consciousnessUsually occurs simultaneously with the tonic Phase Followed by deep post ictal phase |
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Qualities of atonic seizures
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Also known as drop attacks
Sudden loss of muscle tone Begin suddenly without warning Rear and usually confined to Childhood Brief impairment of consciousness No postictal signs |
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These diagnostic tools can help with the diagnosing of seizures
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History and physical
CBCGlucose liver and renal function vdrl electrolytes ana ESRABG serum antiepileptic check levels Urinalysis drug screen Serum prolactin Ct MRI EEG Chest x-ray Lumbar puncture |
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What are seizures diagnosed
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They do not diagnose unless they have a few unprovoked seizure episodes
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Serum prolactin and seizures
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They increase within an hour after seizure
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This is a good marker of seizure activity
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Serum prolactin levels increase
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Initial management of the first time having a seizure
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Supportive therapy
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How eeg help with seizures
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They can help differentiate between the different seizure types and find where the focus is coming from and help with treatment
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Rollup chest x-ray and seizures
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Metastasis
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Medication for absent seizures
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Ethosuximide
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First-line treatment of generalized tonic conic seizures
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Valproic acid
Limictal Topamax |
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First-line agent for partial seizures
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phenytoin
Valproic acid Carbamazepine |
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First-line agent for absent seizures
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Valproic acid
ethosuximide |
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What is the seizure prognosis poor
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When it is linked to an underlying etiology for example brain tumor
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Prognosis of primary epilepsy
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Usually go out of their seizures or maybe well controlled with medication
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When a surgical management needed for seizures
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In tractable seizures
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defind status epilepticus
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This is a medical emergency
More than 30 minutes of continuous seizure activity or recurrent seizure activity without any intervening period of consciousness |
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Complications of status epilepticus
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Hypertension
Lactic acidosis Hyperthermia Respiratory compromise Pulmonary aspiration Rhabdo Irreversible neurologic damage |
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First that in managing status epilepticus
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Benzo's lorazepam or diazepam
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If the patient continues having seizure like activity after giving benzo what is the next step
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Antiepileptic drugs like fosphenytoin or phenytoin
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If the patient continues having seizure like activity while on phenytoin and after giving high doses of benzodiazepines what is the next that
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Phenobarbital infusion 20 mg per kilogram at 50 mg per minute
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Difference between fosphenytoin and phenytoin
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fosphen infuses faster doesn't cause cardiac depression
Compatible with dextrose No skin necrosis pheny: Is alkaline and can cause tissue necrosis |
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cons of phenobarbital infusion
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Causes low blood pressure respiratory depression and prolonged sedation
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Management of status epilepticus that is be from three to typical medication management
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Propofol
midazolam Pentobarbital Intubation ventilationEKG monitoring |
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Most effective medications to treat refactory status epilepticus
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Pentobarbital
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Most common primary tumor is
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Glioblastoma multiforme
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Second common primary tumor is
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Meningioma
Astrocytoma |
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Manifestations of brain tumors
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Depends on type and location and how quickly it develops
Headache nausea vomitingNausea may not preceed vomiting Sensory disturbances weakness Hemiparesis Irritability emotional labilityForgetfulness Drowsiness Lethargic Impaired gait Aphasia Papilledema diplopia Diminished visual acuity Generalized or focal seizure activity |
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Most common clinical manifestations of brain tumor
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Generalized or focal seizure activity
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Highly sensitive test for diagnosing a tumor
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MRI
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How is a CT scan helpful in tumor
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Screening and to follow progression of the tumor
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How was cerebral angiography helpful with tumors
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Helps to determine vascularity of lesions and proximity to blood vessels
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These diagnosing tools can help with brain tumors
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MRI
MRA/Cerebral angiography CT EEG Open brain biopsy Metastatic workup |
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Management options for brain tumors
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Chemotherapy
Radiation therapy Steroids osmotic diuretics Anticonvulsants Breakytherapy Noninvasive stereotactic guidance Surgical shunting |
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Most malignant brain tumors respond to which treatment
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Radiation
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Purpose of corticosteroids with brain tumors
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Decrease edema associated with the tumor
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Purpose of diuretics for brain tumors
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Decrease intracranial pressure
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Purpose of noninvasive stereotactic guidance in brain tumors
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non Surgical way to deliver high doses of medications and minimize damage to surrounding tissuen
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Define encephalopathy
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Dysfunction of the brain secondary to disease or disease process
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Causes of encephalopathy
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Infection
Hepatic Hypertension Metabolic Electrolytes Uremic Anoxic ischemic Hypercapnic endocrine aids Thymine deficiency |
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Manifestations of encephalopathy
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Depends on the cause and can include
Headache Inattentiveness In. Judgment Motor incoordination Drowsiness Confusion Stupor Coma |
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How to diagnose encephalopathy
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Depends on the clinical event
Physical presentation Sera lab analysis CSF analysis EEG activity MRI |
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Treatment of encephalopathy
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Treats underlying cause
ABCs of emergency care Prevention of irreversible injury Anticonvulsant therapy for seizures (phenytoin 300mg/day) Correct underlying cause |
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Define hydrocephalus
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Disturbance of cerebrospinal fluid formation flow or absorption leading to an increase in volume occupied by this fluid into central nervous system
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Major types of hydrocephalus
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Congenital
Acquired Communicating Not communicating Hydrocephalus ex-vacuo Normal pressure hydrocephalus |
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Defined communicating hydrocephalus
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Non obstructive
Cerebrospinal fluid circulation is blocked at the level of the basal cisternsThe subarachnoid spaceFor the level of the arachnoid granulation CSF is made and only blocked after leaving the ventricles |
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To find non-communicating hydrocephalus
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obstructive
Normal pathway of CSF flow are for some reason occluded from aqueduct stenosis or as a result of local compression from a tumor Ventricles are in large proximal to the block |
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Aqueduct stenosis or compression from a tumor can cause what type of hydrocephalus
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Not communicating
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What is hydrocephalus ex-vacuo
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Usually after Shroke or trauma the brain tissue shrinks
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Triad normal pressure hydrocephalus
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Abnormal gait
Urinary incontinence Dementia |
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qualities normal pressure hydrocephalus
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Increase in cerebrospinal fluid from trauma or hemorrhage
develops slowly does not have increased intracranial pressure and can be confused with different disorders like Alzheimer's and Parkinson's |
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Clinical manifestations of hydrocephalus
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Slowing of mental capacity
Cognitive Deterioration Headache in the morning neck pain Suggest tonsillar herniation Vomiting in the morning Blurred visionFrom papilledema Double visionFrom unilateral or bilateral six nerve palsy Difficulty walkingSecondary to spasticity Drowsiness |
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Physiology of difficulty walking with a hydrocephalus
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Affects the lower limbs because the periventricular pyrimidal tract is stretched by hydrocephalus
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Diagnostic tools for hydrocephalus
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Labs are usually not useful
neuro Evaluation Ultrasound Isotopic cisternography CT scan MRI Pressure monitoring techniques |
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What is isotopic cisternography
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Helps in evaluating hydrocephalus
Injecting radio active isotopes into the lower back through the spinal tap Allows the absorption of csf To be monitored over a period of timeUp to four days Helps with diagnosis ofNormal pressure hydrocephalus |
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What will a CT show with hydrocephalus
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Ventricles are enlarged or if there is an obvious blockage
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What will an MRI show for hydrocephalus
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CSF flow and reveal if the ventricles are enlarged
Provides more information than the CT scan |
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What diagnostic tool can really help with hydrocephalus
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MRI
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These medications decrease CSF secretion
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Acetazolamide
furosemide |
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Increases CSF reabsorption
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Isosorbide but the effectiveness is questionable
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Surgical treatment for hydrocephalus
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VP/ va shunt commonlyendoscopic third ventrulostomy
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Most common cause of spinal cord injury
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Motor vehicle accident
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Causes of spinal cord injury
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Motor vehicle accident
falls Acts of violence Sports related Penetrating wounds |
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How is acute spinal cord injury cause
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Direct physical force that damages either ligaments vertebral or disks of the spinal column
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Primary injury of acute spinal cord injury
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Occurs at the moment of trauma
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Secondary injury of acute spinal cord injury
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Occurs 3 to 5 days after injury and can last weeks
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defind complete acute spinal cord injury
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Total loss of motor and sensory below the level of injury caused by transection
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Defined incomplete spinal cord injury
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The effects depend on the area of the cord either front back or side that is affected
the part of the cord damaged depends on the force involved in the injury |
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Qualities of complete spinal cord injury
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Immediate complete flaccid paralysis with loss of all sensory function and reflexes and causes autonomic dysfunction below the level of injury
Within hours to days the flaccid paralysis becomes spastic paralysis if lumbosacral not involved deep tendon reflexes will return and be hyperreflexive |
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theses are type of incomplete spinal cord injuries
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Brown-sequard
Anterior cord syndrome Central cord syndrome Posterior cord syndrome |
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Qualities of brown-sequard
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Hemisection of court usually caused by a penetrating trauma
Results in loss of motorVibrationAnd proprioception Below the level and on the same side as the injury and contralateral loss of pain and temperature can move but have no feeling and have feelings but cannot move |
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Qualities of anterior cord syndrome
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Injury to the anterior spinal artery causing is ischemia to the anterior two thirds of the spinal cord
Vibration light touch and proprioception remain intact and temperature motor and sensation below the level of injury Are loss |
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Qualities of central cord syndrome
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Seen with cervical trauma
In patients with pre-existing cervical spondylosis who sustain a hyperextension injury Motor weakness more severe in arm Then in legs Varying sensory dysfunction depending on which sensory tracts are injured Often seen in sports injuries |
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Posterior port syndrome qualities
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Rare injury resulting from disruption of the posterior column
Decreased in touch propriception and vibration |
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Total loss of motor and sensory below the level of injury
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Complete spinal cord injury
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Immediate complete flaccid paralysis with loss of all sensory function and reflexes and causes autonomic dysfunction below the level of injury within hours today's flaccid paralysis turns into spastic paralysis
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Complete spinal cord injury
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Incomplete spinal cord injury if Lumbo sacral area is not involved with what happened
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Deep tendon reflexes will return and be hyperreflexive
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Loss of motor vibration and Proprioception below the level and on the same side as the injury and contralateral loss of pain and temperature
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Brown-sequard
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Vibration light touch and proprioception remain intact and temperature motor and sensation below the level of injury on loss
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Anterior cord syndrome
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This type of a cute spinal cord injury is seen with cervical trauma and sports related
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Central cord syndrome
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Decreased in touch proprioception and vibration
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Posterior cord syndrome
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Qualities of spinal shock
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Loss of all spinal cord function including reflexes
Happened immediately after spinal cord injury and can last hours today's With injuries occurring at T6 and above Bradycardia and hypotension is seen during this stage because of lots of sympathetic outflow vasodilation and vagal stimulation to the heart |
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Why do we see bradycardia and hypotension in spinal shock
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Loss of sympathetic outflow
Vasodilation And vagal stimulation to the heart |
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Spinal shock often occurs with injuries at what level
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T6 and above
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Can you tell a prognosis when the patient is an spinal shock
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No don't make any predictions about recovery while in spinal shock
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Diagnostic procedures for assessing cervical region
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Cross table lateral position first
Anteroposterior x-ray if lateral is abnormal Open mouth Odontoid x-rayFor conscious patients to visualize the C2 Lateral swimmer view |
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In a crossed table lateral position what must be visualized
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All seven vertebra cervical
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If lateral X-ray for cervical vertebra is abnormal what is the next that
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Obtain an anteroposterior x-ray
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What diagnostic view helps you you visualize the C2
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Open mouth odontoid x-ray this is for the conscious patients
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How many thoracic and how many lumbar vertebra can be visualized any lateral and anteroposterior view
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12 thoracic five lumbar
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Helps detect compression of the cord by herniated discs bone fragments or foreign matter that need surgical invention
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Myelogram
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Superior diagnostic procedure for spinal cord injuries
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mri
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Number one management and spinal cord injury
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Consult neurosurgery
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Management in spinal cord injury
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Neurosurgery
Maintain airway Immobilize Fluids Bladder catheterization NG tube |
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When steroids were using spinal cord injury what is the best way to use them
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In the early hours of injury to help reduce the extent of permanent paralysis during the rest of the patient's life usually given within the first eight hours of trauma
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Difference between spinal shock and hypovolemic shock
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Spinal shock will have decreased heart rate and warm skin
Hypovolemic shock will have increased heart rate cool clammy skin |
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What are some predictors of survival of acute spinal cord injury
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age
Level of injury Neurologic grade for rating scaes like American spinal injury Association scale |
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Defined brain death
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irreversible cessation of all functions of the entire brain including the brainstem
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Qualities of brain death
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Irreversible coma
Loss of brainstem reflexes Apnea Absence of cortical activity Absence of motor response to pain |
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Diagnosis of brain death is a clinical diagnosis that contains three cardinal findings what are they
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Coma
Apnea Absence of brainstem reflexes |
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Before performing brain death examination what must you do
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Exclude other confounding conditions like hypothermia locked in syndrome and guille barre
Warm them up before diagnosing brain death |
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What is a coma
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Absent cerebral motor response in all extremities and face to noxious stimuli like nailbed and supraorbital ridge pressure
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If you are assessing nailbed pain response what are you assessing for
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coma ex of noxious stimuli
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How do you assess the absence of brain and brainstem function
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Pupils size will be midposition to dilated 4-9 mm
There will be absent response to Brightlight Absent corneal reflex Absent gag reflex Absent cough flex Check ocular movement |
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What is the hallmark of Brain death
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Apnea
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Define apnea
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Persistent absence of all respiratory efforts in the presence of an acute increase in arterial CO2
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When assessing for apnea what must you ensure
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That the patient must be normothermic
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When assessing for Apnea the test may cause...
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Hypotension
Hypoxemia Cardiac dysrhythmia |
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How do you perform an apneatest
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Pre-oxygen with 100%
minute Ventilation is set to patients normal but never nested 40 Patient is separated from the ventilator Oxygen insufflated into ET tube After 8 to 10 minutes arterial blood gases samples It apnea persists Despite a rising CO2Over 20The test is positive and consistent with diagnosis of brain death Begin with CO2 of at least 40 |
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Why is it import when performing an apnea test that the patient is normothermia
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Because patients were hypothermic we'll not have an increasing CO2
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When is it apnea test positive and what does it mean
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If Atnia it persists despite arise in CO2 over 20 the test is positive and consistent with diagnosis of brain death
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Had an acute nurse practitioner make the diagnosis of brain death
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No it must be done by two physicians one being a neurosurgery and the second preferably a critical care physician
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leading cause of death between ages one and 45 |
traumatic brain injury
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Leading cause of Trumatic brain injury in adults
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Falls
Motor vehicle accidents Violence Combat related trauma |
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List the area of the Brain from the scalp to brain matter
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Scalp
Skull Dura matter Arachnoid Subarachnoid space Pia matter Brain |
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Outer layer that is hard and protects the brain
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dura mater
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Area where cerebrospinal fluid is transferred from the v ventriclesto the bloodstream
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Arachnoid
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In your area that covers the brain where cerebrospinal fluid is made
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pia mater
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Defined cerebral perfusion pressure
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Gradient across the brain
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What are determinants of cerebral hemodynamics
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Blood brain barrier
Cerebral perfusion pressure |
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What is the equation for cerebral perfusion pressure
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MAP-ICP
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cpp level where brain is scheming occur |
Less than 40
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Normal CPP
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50 to 160 the most normal 60-100
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How can disruption of the blood brain barrier lead to brain edema
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It causes vasodilation and exposure of the brain to other chemicals
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What are some things the body tries to do to maintain CPP
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Hyperventilate which causes hypocapnia this causes vasoconstriction and increasing pressure in the brain
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things that causes vasodilation in the brain
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Hypotension acidosis hypercarbia
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Things that causes vasoconstriction in the brain
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Hypertension alkalosis hypocabia
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GCS mild injury
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13 to 15
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GCS moderate injury
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9 to 12
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GCS severe injury
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Eight or less
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Benefits of using GCS
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Universally accepted
Easy reproducible |
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GCS measures what three factors
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eye response
Verbal response Motor response |
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Best eye respond gsc score variables
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1 none 2To pain 3To verbal command 4Spontaneously |
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Best verbal response GCS score variable
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1 no verbal response 2Incomprehensible sound 3Inappropriate words 4Confused words 5Appropriate verbal response |
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Best motor response GCS score variable
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1 no motor response 2Extensions of pain 3Flexion to pain 4Withdrawal from pain 5Localized paint 6 Obeys commands |
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What are some limitations when using the Glascow coma scale
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Sedation intubation alcohol use
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Frontal portion of the brain controls
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Higher intellect
Self-control Inhibition Emotion Voluntary eye-movement Motor and speech production Voluntary movement Motor skills development |
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Parietal portion of the brain has these functions
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Sensation
LanguageComprehension |
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Occipital portion of the brain has this function
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Visual
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Temporel portion of the brain has this function
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Auditory and memory
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Cerebellum has this function
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Equilibrium and muscle coronation
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Part of the brain that controls auditory and memory
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Temporel
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Part of the brain that controls equilibrium and muscle coronation
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Cerebellum
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Part of the brain that controls language comprehension and sensation
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Parietal
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Part of the brain that controls motor and speech production and voluntary movement
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Frontal
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Biomechanics of head trauma can be divided into
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Direct injury indirect injury
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Qualities of direct injury
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Head is struck by an object or its motion is arrested by another object
Results of compression of the head |
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Qualities of indirect injury
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Accelerated deceleration injury
Shaken impact syndrome Cranial contents are set in motion by forces other than direct contact of the skull within object |
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Define primary brain injury
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Mechanical damage that occurs at the time of head trauma
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Examples of primary brain injuries
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Brain laceration
Hemorrhage Contusion Tissue avulsion Permanent mechanical cellular destruction Microvascular injury |
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How do you treat primary brain injury
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It is difficult to treat and difficult to prevent there is not a lot that can be done no specific intervention to repair or reverse injury
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What is secondary brain injury
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Results from intracellular and extracellular derangements that'll probably initiated at the time of trauma by a massive depolarization of brain cells and subsequent ionic shifts`
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Hauto cells protect themselves from secondary brain injury
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Several compensatory mechanism like endogenous free radicals scavengers and antioxidants however what's significant trauma these systems are quickly overwhelms and the functional integrity of the cells are threatened
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Number one goal of head injury is
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To prevent secondary systemic insults
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What are some secondary systemic insults that can occur with brain injury
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Hypotension SPP less than 90
Hyperpyrexia 38.5C HypoxiaPo2 less than 60 Anemia Hematocrit less than 30% |
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What can occur with hyperpyrexia and brain injury
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Stimulation of metabolism and injured areas of the brain that's recruiting blood flow with it resulted increasing intracranial pressure so in other words increases the capitalism which will cause more blood to flow to that area and that's can increased intracranial pressure
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Common mechanisms of primary brain injury
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Direct impact
Rapid acceleration or deceleration Penetrating injury Blast waves |
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Damage that results from primary brain injury includes
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Focal contusion
Hematoma Shearing of white matterAlso known as diffuse axonal injury Cerebral edema and swelling |
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CT shows multiple small lesions within white matter tracts
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Diffuse axonal injury
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Patients with diffuse axonal injury will present with
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Profile coma without elevated intracranial pressure
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Where does diffuse axonal injury involved
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Gray white junction in the hemisphere
More severe injuries affect the corpus callosum or midbrain injury is greatest where density differences is greatest most tearing occurs at the gray white matter junction |
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What causes diffuse axonal injury
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Sudden celebration deceleration forces that causes a shearing mechanism
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What is cerebral contusion
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Bruises on the surface of the brain caused by impact injury
Contusions are produced when parenchymal blood Vessels or damage resulting in scattered areas of petechial hemorrhage and edema |
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Coup injury
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Contusion occurs on the same side as the impact
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counter coup injury
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If the contusion occurs on the opposite side as the impact
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Presentation of cerebral contusion
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It can be delayed
May have brief loss of consciousness May also cause significant nurologic problems Overall varying symptomsFrom brief LOC too obtunded Elevated ICP Focal deficits May need surgical intervention |
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Best way to discover contusion in the early posttraumatic period
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Noncontrast CT
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Epidural hematoma qualities
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From direct impact injury that causes of forceful deformity of the skull
Unilateral 20% of patients have other intracranial lesionsLike sdh or contusions Detected rapidly Arterial bleed Usually in the Temporel area because the bone is very fragile Not associated with underlying brain damage And does not cross suture lines Usually associated with skull fracture |
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Signs and symptoms of epidural hematoma
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Headache drowsy dizzy nausea vomiting but does not occur right away usually occurs after bleeding for A while
Brief episodes of LOC then get better lucid intervals due to the arterial bleed lapses in and out of consciousness until they lose mental status Dilated pupils usually on the side of injury Decreasing motor strength |
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When a surgical intervention needed in an epidural hematoma
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Greater than 30 cm in volume
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One is there a poor prognosis with epidural hematoma
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If the patient presents with coma
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Caused by fracture of the Temporel bone and rupture of middle meningeal artery
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Epidural hematoma
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Where is the bleed in an epidural hematoma
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Between the bone and the dura mater
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Where is the bleed any subdural hematoma
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Between the dura and subarachnoid and can also cause injury to brain tissue
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Qualities of subdural hematoma
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Between the dura and subarachnoid
Venous bleed slow Diagnosis is not apparent for hours to days after injury Rupture of urgent things in the subdural space Can grow large enough to act as masses and are associated with high morbidity and mortality rates More common than epidural hematoma Crescent shaped on CT scan Can cause shifting |
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Bleed cause by rupture of the bridging veins in the subdural space
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Subdural hematoma
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Presentation of subdural hematoma
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Depends on amount of brain injury sustained at the time of trauma and the rate of the expansion headache nausea vomiting slurred speech loc fluctuates
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Acute subdural hematoma
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Symptomatic within 24 hours after trauma
Decreased LOC GSc less than 8 40 to 60% mortality |
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Subacute subdural hematoma
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Symptoms between 24 hours til 2 weeks after injury
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Chronic subdural hematoma
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Symptomatic two weeks or more after trauma
s&s may be subtle or nonspecific may hav altered level of consciousness unilateral weakness or hemiparesis |
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People pour at high risk for subdural hematoma
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Alcohol use and falls
Elderly and on anticoagulant |
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traumatic subarachnoid hematoma |
Bleed in the area between the arachnoid membrane and the pia Mater
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Bleed in the area between I arachnoid membrane and the pia Mater
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Subarachnoid hematoma
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What causes subarachnoid hematoma
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Tears of small s subarachnoid vessels
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Signs of Trumatic subarachnoid hematoma
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Thunderclap headaches worse headache in their life that started suddenly photophobia
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Qualities of intracerebral hematoma
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Deep within the brain tissue
From sharing or tensile forces that stretches and tear deep small caliperArterials as the brain is propelled against a irregular surfaces in the cranial vault Small petechial hemorrhages coalese form intracerebral hematoma |
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Intraventricular hemorrhage
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From tearing of subependymal veins or by extension from adjacent intraparenchymal or subarachnoid hemorrhage
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Potentially devastating complication of urologic injury
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Increased intracranial pressure
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Normal ICP
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Less than 15
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When is ICP considered elevated
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Greater than 20
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Intracranial components
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80% rain 10% cerebrospinal fluid and 10% blood
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Basil causes of increased intracranial pressure
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Mass lesions
Cerebral eczema Increased CSF production Decreased CSS absorption Obstructive hydrocephalus Obstruction of venous outflow Idiopathic intracranial hypertension |
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How does ICP and CPP relate
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Conditions associated with elevated ICP can also be associated with a decrease in CPP that can result in focal or global ischemia
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Why do you monitor map with head injuries
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To monitor your CPP and assessed for ischemia
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Manifestations of increased ICP
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Headache decreased consciousness vomiting
Papilledema pupillary changes Impaired I movement decerebrate decorticated or flaccid postering Decreased motor function changes and in motor ability posturing Seizures in. Sensory and motor function Changes and vital signs cushions triad Changes in speech |
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Why do people with increased ICP have headaches
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Mediated by pain fibers in cranial nerve five in the dura and blood vessels
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Wife they're decreasing consciousness with elevated ICP
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Local effect of mass or pressure on the midbrain reticular formation
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Cushing's triad
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Hypertension(increasing systolic and pulse pressure) bradycardia altered respiratory pattern
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Decerebrate
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Posturing results from damage to the upper brainstem arms are adducted and extended with the wrists pronated and the fingers flex the legs are stiff and extended with plantar flexion of the feet
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Decerebrate posturing has these qualities
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Arms adducted
Arms extended Wrists pronated Fingers flex Legs stiff Legs extended Plantar flexion of the feat From damage to upper brainstem |
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Decorticate quantities
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Posture results from damage to one or both corticospinal trucks
Arms are adducted Arms are flex Wrists and fingers are flex on the chest Legs are stiff Legs extendedAnd internally rotated Plantar flexion of feet |
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Which is worse to celebrate or to corticated and why
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Decerebrate shows brain damage and is worse decorticate a nerve pathway disturbance
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Late sign of intracranial hypertension
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Cushing's triad
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What is herniation
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Mechanical displacement of normal brain relative to another anatomic region secondary to mass effect from trauma neoplastic ischemic or infectious etiology
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Common site where brain Herniates
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Foreman magnum
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When is invasive monitoring of ICP indicated
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Suspected to be at risk for elevated ICP
ComatoseGSC less thn eight Diagnosis with a process that merits aggressive medical care |
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Gold standard for monitoring ICP
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Intraventricular
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Benefits of intervention and monitoring of ICP
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You can monitor ICP And drain CSF fluid
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Risks of intraventricular monitoring
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Infection and hemorrhage
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Pros and cons of intraparenchymal monitoring
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Easy to place low risk of infection and hemorrhage but you cannot drain CSF fluid also it may not be liable because you cannot recalibrate the c transducer after placing it so you lose accuracy
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Cons of subarachnoid monitoring
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Clots
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Patients who are coagulopathic may benefit from this type of ICP monitoring
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Epidural
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Pros and cons of epidural monitoring
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Less invasive less chance of hematomas benefit for patients who are coagulopathic but make it in accurate readings because it is close to the Dura and dampens the numbers
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Which imaging will be best for posttraumatic ischemic infarction subacute nonhemorrhagic lesions and contusions axonal shearing injury
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MRI
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Which imaging would be best for cerebral swelling subarachnoid blood ischemic infarction elevated ICP pneumocephalus
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CT noncontrast
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Initial Treatment of elevated ICP
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Head of bed 30°
Keep neck neutral position Monitor CVP Avoid excessive hypervolemia |
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Treatments for elevated ICP
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osmotic therapy
Hyperventilation Sedation CPP Antiepileptic trucks Temperature management Glucose control Hemostatic therapy Glucocorticoids |
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How can hyperventilation be used to decrease intracranial pressure
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CO2 decreases which causes vasoconstriction and decreasing cerebral blood volume and ICP
Not for acute phase after Trumatic brain injury Mild to moderate hyperventilation can be considered later but not too PCO2 below 30 |
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how osmodic therapy help with ICP
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Creates an osmolar gradient drawing water across the blood brain barrier leads to decreasing interstitial volume and decreased ICP
Monitor Serum osmol maintain less than 320 Monitor electrolytes load-balancing renal function |
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How does sedation help with icp
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Can lower ICP by reducing metabolic demand
Improves vent synchronyBlunts sympathetic response of hypertension tachycardia However it can cause hypotension and cerebral vasodilation that may aggravate people hypoperfusion and elevate ICP |
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Propofol infusion syndrome
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Acidosis hyperkalemia renal fail, rhabdo cardiovascular collapse with propyl fall levels greater than 4 mg per kilogram per hour
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Cheat me option for elevated ICP refractory to other therapy
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Barbiturate coma pentobarbital thiopental
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Wise import into to get antiepileptic drugs after trumatic brain injury
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Avoid potential convulsions to aggravate a systemic injury
Because seizures may increase cerebral blood flowAnd could increase ICP Seizures place a metabolic demand on the brain tissue and can activate secondary brain injury |
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What is the purpose of giving antiepileptic drugs after Trumatic brain injury
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Is a cute management overdramatic brain injury you can reduce early seizures but does not prevent the leader development of epilepsy
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Why manage temperature after Intermatic brain injury
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Fever worsens outcomes after stroke and probably severe head injury by activating secondary brain injury
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Induced hypothermia and ICP
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Has potential to reduce ICP as well as provide protection and prevent secondary brain injury consider for improving outcome after vfib and cardiac arrest
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Unconscious no eye-opening no motor no sound gcs?
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Three
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Confuse open eyes verbal follows simple commands
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13th
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