Neurologic Support
12 important questions on Neurologic Support
What are common mechanisms of primary brain injuries?
Ischemia
inflammation
compression: hematoma
metabolism:
What are common mechanisms of secondary brain injuries?
hypoxia: systemic / regional hypoperfusion, seizures, hyperthermia
electrolyte or acid base chagnes
reperfusion injury with free radical formation
What is the primary goal in brain injury management?
- Higher grades + faster learning
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Cerebral blood flow is usually evaluated by cerebral perfusion pressure (CPP),
normal = 60 - 100 mmhg
What are the general principles of managing brain injury?
avoid seizurs
avoid anxiety, agitaiotn or pain
avoid shivering
minimize stimulation, particulary for the first 72 hours
What clinical findings suggest herniation?
Cushing reflexic of hypertension by bradycardia and altered respiration may indicate brain herniation.
Disconjugate eye moments
change in respiratoyr pattern
deerioation in motor respons ( EMV ) --> increas in intracranial mass effec
In the case of a suspicion of herniation, what are important steps to take?
Mannitol / hypertonic saline
A brief period of hyperventilation ( alkalosis --> vasoconstriction --> ICP lower yet higher chance of increased secondary ischemia )
What medication should be avoided in traumatic brain injury patients?
What drugs should be avoid in intracerebral hemorrhage?
What is the treatment of SAB?
2. control bloodpressur early ( rebleeding is the major complication early on ) labetalol and nicardipine have een advocated.
3. initiate oral nimodipine, 60 mg every 4hours ( hypotension should be avoided )
4. avoid hyponatremia, which is commonly encountered.
How to treat a seizure?
in the case of seizure activity it should be followed by i.v. dose of phenytoin or fosphenytoin.
When is a lumbar puncture allowed without performing a CT-scan
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