Term
| Number 1 thing to check with neuro assessment? |
|
Definition
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|
Term
| What are the levels of LOC (6) |
|
Definition
Alert
Lethargic
Obtunded- follows command to non painful
Stupourous- follows command to painful
Comatose
Hyperarousal |
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Term
| What is nouxious stimulous? |
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Definition
|
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Term
| What are examples of noxious stimulous? |
|
Definition
Sternal rub- never first
Supraorbital- press abouve eye
Trapezious pinch- (first)Press above shoulder
Mandibular- Press @ Jaw
Mandibular |
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Term
| The 4 hs that negate/ invalidate the neuro exam? These cause decrease in LOC |
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Definition
Hypotension
Hypoxia
Hypoglycemia
Hypothermia |
|
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Term
|
Definition
Eyes- ability to open 1-4
Verbal- can speach? Lose this once intubated 1-5
Motor- How respond to command? 1-6 |
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Term
| What do the totals of the GCS mean? |
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Definition
<8 = severe
9-12 moderate
13-15 mild |
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Term
| How to assess motor in Neuro assessment |
|
Definition
Strength scale 1-5
Lateral comparison
Withdraw/ Localization
Posturing
Noxious stimulous |
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Term
| Which postering indicates brain stem damage |
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Definition
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Term
| During eye assessment what does it mean when pupils fixed when head is turned |
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Definition
| Negative dolls eyes- this is an indicator of brain death |
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Term
|
Definition
Increase SBP
Decrease HR & RR
(Cushings Triad) Indiated pressure on brain stem |
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Term
|
Definition
If gagging, breathing above vent, positive dolls eyes rule out brain death.
EEG & Evoked potentials- Last choice |
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Term
|
Definition
| Evaluation of cerebral blood flow with ultra sound= Flood flow decreases with brain death |
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Term
|
Definition
Normal= Jerking eye dame side
Abnormal= Jerk eye Oposite side |
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Term
|
Definition
Pre 02 with 100% for 10 min
Disconnect vent continue 02
observe reso
After 10 min draw ABG
If apneic & PCO2 >60: supports brain death |
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Term
|
Definition
0-15mmhg
Greather then 20 = impending herniation |
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Term
|
Definition
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Term
|
Definition
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Term
| What happens to Cerebral BF in TBI |
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Definition
Blood flow is decreased by 50% in first 24 hours- 2weeks following injury,
HIGH RISK FOR ISHEMIA- DON'T COMPROMISE BF AT THIS TIME. |
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Term
| What happens when cerebral BF is low? (Metabolic- CO2) |
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Definition
Autoregulation
Hypocapnia ( d/t hyperventilation blow off c02- cerebral vasoconstriction- cerebral ishemia
Hypercapnia-vasodilation- IICP
Goal PCo2 35-45 po2 >100 |
|
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Term
| What happens when cerebral BF is low? (Pressure) |
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Definition
Increase BP- Vasoconstriction (good if iicp bad for perfusion)
Decrease BP- dilation (good for perfusion bad for IICp)
MAintain normal BP |
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Term
|
Definition
Perfusion Pressure- BP, ICP
02 or Glucose- Hypoxia Anemia, Hypo Glycemia, C/O
Vascular resistance- Vasospasm, thrombosis, cerebral edema, hypocapnia
Metabolic demand- fever, seizure, agitation |
|
|
Term
| Normal Brain tissue oxygenation |
|
Definition
20-35mmhg
PbT02 maintained by balancing
CPP >50
Icp<20 |
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Term
| When should ICP be monitored in TBI? |
|
Definition
GCS 3-8= severe
Abnormal CT
Normal CT with >2 risks factors ( >40, posturing, SBP <90) |
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Term
| Drain that decreases CSP to decrease ICP |
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Definition
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Term
| ICP devise that lets you sample CSF only |
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Definition
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Term
| ICP monitoring that measures pressure but has no access to CSF (2) |
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Definition
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Term
| Types of Head injury forces? |
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Definition
Acceleration- object toward head
Deceleration- head moving (Mv crash)
Roational
Penetrating (knife, gunshot) |
|
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Term
| Primary Head Injury ( Diffuse) |
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Definition
|
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Term
| First type of diffuse head injury= Concussion |
|
Definition
Brief LOC, N&V, Photophobia
Immediate disorientation
Impaired balance w/i 1 day
slower reaction time w/i 2 days
impairedd verbal learning and mem w/i e days
Dx- CT scan to r/o focal injury |
|
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Term
| Diffuse type of head injury ( DAI) |
|
Definition
Acute & prolonged coma, Cushing triad, posturing, increase temp ( not easily treated with ty/asp)
Diffuse axonal injury, severe, permanent shearing of axons |
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Term
|
Definition
Pupils are effected on the same side= lipsilateral
Motor is effected on the opposite side= contralateral |
|
|
Term
|
Definition
| Judging, knowing body position, understanding and remembering things we do and see, put info together to create entire pic, controls left side of body |
|
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Term
|
Definition
Understanding and use of language
memory for spoken and written messages, detailed analysis of information
controls right side of body |
|
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Term
| Primary head injury Focal (Contussion) |
|
Definition
bruising and swelling
Coup Primary inpact
Contracoup secondary inpact |
|
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Term
| with contusion what happens if their is damage to temporal or parietal? |
|
Definition
Causes damge to midbrain and r/o epidural hematoma
sx- Contralateral motor, lipsilateral pupil change, altered loc
Goal- min ICP max CCP |
|
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Term
| Focal injury (skull fracture) |
|
Definition
Linear= minor hairline
Depressed= move toward brain causes potential to compress brain tissue. |
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Term
| Ify you see bloody drainage from a patients nose following a head injury what should you do? |
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Definition
| Mestach dressing IF + CSF= HALLO... NEVER PUT ANYTHING IN THE NOSE |
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Term
|
Definition
Raccoon's eyes: Periorbital ecchymosis
Battles sign = mastoid ecchy
CSF leak- Rhinnorhea, Ottorhea.. Need atb d/t increase r/o meningitis |
|
|
Term
|
Definition
Arterial Blood= quickly
decrese LOC, followed by lucid followed by coma. |
|
|
Term
|
Definition
Venous blood- can be quick or slow
Gradual decrease loc, or chronic onset, motor and pupil change.
Increae r/o repeat bleed |
|
|
Term
|
Definition
Blood collection w/i brain tissue
Pupil and Motor effect + s/s of lobe of brain effected. |
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|
Term
|
Definition
Aneurysm- D/t increase BP from stress
Happens at Circle of Willis |
|
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Term
|
Definition
| Thundering ha, photophobia, decrease LOC, N&V , nucheal rigidity |
|
|
Term
|
Definition
Vasospasm- causes ishemia
Vision changes, hemiparesis, seizure, aphasia, decrease loc |
|
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Term
| Vasospasm diagnosis and treatment |
|
Definition
dx- Trancranial Doppler
TX- 1st Nimodipine- CCB that targets BV of brain relaxes arteries and has no systemic responce |
|
|
Term
|
Definition
Only use if drug nimodopine dont work
Hypertension goal SBP >200 ( Norepi)
Hemodilution- dilute blood, HCT 30 norm is 40-45 |
|
|
Term
|
Definition
| Hypoxia, Hypercapnia, Hypotension, HTN, cerebral edema( shift to left or right= pressure on one side of brain. |
|
|
Term
Secondary injury- herniation
Uncal vs Central |
|
Definition
Uncal = 1 side
Central= diffuse injury both sides
Temporal lobe forced into tentorial notch = brain steam compression |
|
|
Term
|
Definition
Pupils fixed and blown
Dolls eyes neg
cushing triad
c-v collapse- death |
|
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Term
| Early s/s of Herniation give what/ |
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Definition
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Term
| Treatment for intracerebral edema |
|
Definition
Mannitol- Requires intact BBB, has rebound effect
Hypertonic saline- >.9% raises osmotic pull, no rebound |
|
|
Term
|
Definition
Barbituates to control IICP
Propofol not to be used in high doses over 48hrs. |
|
|
Term
|
Definition
Hypotonic fluids
replace ADH Vasopressin or DDAVP
sx Polyuria >200, Increase blood sodium, decrease urine SG. |
|
|
Term
|
Definition
FLuid restriction, Hypertonic fluids
sx. Oliguria, blood sodium low, urine sodium/ Sg high |
|
|
Term
|
Definition
No pen of skin
Acceleration- increase in speed of moving object- pedestrian thrown from car
Deceleration- slow down victim strikes steering column
Shearing forces- tearing of tissue
external and internal injuries common |
|
|
Term
| Common trama related to blunt trama |
|
Definition
| Lacerate liver and spleen, rupture stomach, bowl porforated causing peritonitis and sepsis, bruise deuodmn, damage kidneys |
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|
Term
|
Definition
| Causes greatest injury in most blunt tramas |
|
|
Term
|
Definition
Penetration of skin
External would not reflective of internal injury- stabbing/gunshot |
|
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Term
| Blunt and pen injuries are accociated with |
|
Definition
Damage to solid organs
Masssive bl= hypovolemic shock
Damage to hollow organs= infection |
|
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Term
| Top 3 areas of fetal injury |
|
Definition
|
|
Term
|
Definition
Carotid-60
Femoral- 70
Radial- 80 |
|
|
Term
|
Definition
Goal Indetification and treatment of life threating injuries
ABCDE |
|
|
Term
|
Definition
Tells mnemonic for disability
A- alert
V- repsonds to verbal
P- Responds to painful
Unresonsive |
|
|
Term
|
Definition
Goal identification of all injuries
- Keep pt warm
get vs and add tubes and caths
head to toe
inspect posterior surfaces
Reasses abcd & vs |
|
|
Term
|
Definition
Black- dead
Red- serious immediate
Yellow less serious transport up to 1 hr
Green delayed up to 3 hrs |
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Term
|
Definition
| 3 key areas respiration, pulse & mental statues |
|
|
Term
|
Definition
open airway/ insert airway.. no cpr
stop bleeding
elevate extremities |
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|
Term
| Immediate tx if mass when |
|
Definition
Resp over 30
Perfusion= cap refill over 2
Unable to follow simple command |
|
|
Term
|
Definition
Only shows peritineal fluid
u/s, quick... NOT USEDFUL FOR RETROPERITONEAL BLEEDING |
|
|
Term
|
Definition
Can't be done at beed side, can only use this if patient is stable and able to be moved
SHOWS RETROPERITONEAL BLEEDING |
|
|
Term
PERITONEAL LAVAGE
( blunt/ abd trama) |
|
Definition
| Invasive- peritoneal cath inserted into abd & warm NS or LR instilled then drained.. look to see if their is color change. |
|
|
Term
| Which of the following test is the mainstay of diagnstic evaluation in a pt with blunt abd trama who is hemodynamically stable |
|
Definition
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|
Term
| What are the early complications from tramatic injuries |
|
Definition
Hemorrage #1 early killer/ hypovolemic shock most common w/ trama
Hypothermia
Acidosis
Fluid overload- increase r/o ards
Sirs- activated by tissue injury, bld loss and contaminated wounds
#1 late killer= infection &MODS |
|
|
Term
| If Impalement injury do what? Examble metal in eye |
|
Definition
Dont pull out must xray.
Stablize/ support object
tape in place if possible
OBJECT REMOVED IN OR |
|
|
Term
| What to do with tramatic amputation |
|
Definition
Clean AMP.. Keep on ICe and Put in 2nd bag of ice.
Rember ABCD
Control bleeding- elevate and apply pressure |
|
|
Term
| What is the worry with crushing injuries w/ injured muscle |
|
Definition
Myoglobin is released-
soft tissue swlling
pain
COMPARTMENT SYNDROME FROM MUSCLE TISSUE SWELLING CAUSING COMPRESSION TO BLOOD VESSLS AND NERVES- TX FASCIOTOMY |
|
|
Term
| How does compartment syndrome look? |
|
Definition
|
|
Term
which is a late s/s of compartment syndrome that re3quir4es an emergent faciotomy?
|
|
Definition
| Loss of pulses and sensation to the extremity distal to the injury |
|
|
Term
| Skeletal muscle damage with crushing injuries |
|
Definition
Myoglobin release=( rhabdomylosis) myoglobinuria= Burgundy port wine colored urine
* CPK & Myoglobin labs increase
* ARF- MONITOE K AND CREATINE-
TX- increase IV fluids to maintain UO of at least 100-150ml/hr |
|
|
Term
|
Definition
*lower rib frax- possible abd, organ/ vessel injury
* Ribs 11-12 free floating & can result in liver, spleen, or diaphram injury.
*to fix ribs 1-2 major force needed possible injury to great vessels CHECK PULSES IN ARMS & LEGS, TRACHEAL INJURY HOARSENESS
s/s- dyspnea, pain w/breathing, bruising, paopate chest wall for deformity and SQ air. |
|
|
Term
What happens when their is freely moving segment of rib cage.. 3 or more ribs fx in 2 or more places?
|
|
Definition
| Flail chest movement: paradoxical movement- movement in opposite direction on inspiration and exspiration |
|
|
Term
|
Definition
s/s dyspnea, pain, possible chest wall brusing, hemoptysis
Care- 02, monitor hypoxia, pain management, vent ONLY USE VENT IF FLAIL CHEST LEADS TO DECREASE VENTILATION D/T WILL MAKE CHEST EXSPAND |
|
|
Term
|
Definition
Brusing and bleeding into lung tissue(white out on xray)
often with rib fx
Inflammation process r/o sirs &ards
s/s Hemotysis decreased BS &crackles over affected area. |
|
|
Term
|
Definition
Medical emergency d/t TRACHEAL DEVIATION TOWARD UNAFFECTED SIDE
IMMEDIATE RX NEELE DECOMPRESSION 2ND ICS& MCL |
|
|
Term
| what vent setting increases risk of developing a tension pnemothorax |
|
Definition
|
|
Term
| s/s of tension pnemothorax |
|
Definition
dyspnea
increase rr and hr
absent bs on colapsed side
low BP from decreased c/o |
|
|
Term
| What should nurse do with pt who has open pnemothorax and they hear suckling or bibbling |
|
Definition
| 3 sided dressing to prevent air escape and get chest tubes in |
|
|
Term
|
Definition
Blood in pleural space
chest tube will be put low
s/s
SOB
hypotension
dullness to percussion
tachy |
|
|
Term
| what is a hemopneumothorax |
|
Definition
|
|
Term
| What causes highest mortality rate in cardiac injuries d/t penentrating injury |
|
Definition
Injury of left ventrical common
cardiac tamponade or exsanguination |
|
|
Term
| S/s of cardiac contusion( brusing of hrt) |
|
Definition
Chest pain not relieved by nitro
Dysrthmias, cardiac enzyme elevation |
|
|
Term
|
Definition
+JVD
Muffled heart sounds
hypotension d/t decrease SV & C/O
TX pericardiocentesis |
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