Not doing on every pt just those who are unconscious

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Not doing on every pt; just those who are UNCONSCIOUS . Looking for normal brain stem functioning or not. Additional information to assess unconscious patients. ASSES FOR INTACT SPINE . DON’T do on someone with suspected SPINAL CORD INJURY. Ask patient to keep eyes focused on midline point, you turn their head from side to side, and what you will see is that your patient’s eyes will move contralateral (opposite) to the direction the head is being moved = this is normal finding. (+) POSITIVE doll’s eyes reflex: turn the head and the eyes DON’T move Sign of BRAIN DEATH Oculovestibular Reflex (Cold Caloric) Do on UNCONSCIOUS to assess brain stem functioning. Additional information to assess unconscious patients. You need 50 mL syringe & cold saline. You will instill 50 mL of cold saline into patient’s ear. ASSESS FOR INTACT EAR DRUM: water will go places you don’t want it to go. There is no positive or negative; just looking for NORMAL or ABNORMAL NORMAL : when you instill water, patient’s eyes will deviate to side of where you are instilling water and go back to center. ABNORMAL : if eyes DO NOT move while you are instilling water. Sign of BRAIN DEATH Components of ICP : brain tissue, blood, CSF fluid Monro-Kellie doctrine Increase in any one component requires a reduction in one or both of other components to sustain normal ICP One of the other 2 components has to decrease in order to maintain ICP NORMAL ICP : 0-15 mm Hg Cerebral Perfusion Pressure (CPP) : tells you how well your brain is being perfused. Dependent upon ICP and MAP (CPP=MAP ICP) If CPP is inadequate (<70), ischemia or infarction of brain tissue can occur Optimal CPP > 70 Increased ICP: >20 for 5 minutes or longer 16- 19 ICP is gray area. If pt has ICP of 17, it may be high but doesn’t fall into category of Increased ICP; it is no t too high but not quite normal. Associated with many neurological problems ICP 20mm Hg or greater for 5 minutes or longer Why would my ICP be increased = Results from an increase in any one of the 3 components: 1) Increased Blood Volume Loss of Autoregulation Decreased Oxygenation Hypercapnia: brain vessels will dilate Obstruction 2) Increased Brain Volume Cerebral Edema 3) Increased Cerebrospinal Fluid Hydrocephalus CM: Cardinal sign: LOC changes Late: vomiting, pupillary changes Herniation : when ICP >20 for longer than 5 minutes, our concern is herniation. Don’t need to know different types. Herniation of brain is bad; not conducive to life . Reason we are concerned with increased ICP. Job is to recognize s/s of ICP to prevent herniation from occurring. Usually brain herniates through foramen magnum.
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Critical Care Test 3 (3) Intracranial Pressure Monitoring: INDICATIONS: anyone with severe head injury, patient’s with GCS < 8, stroke, brain tumors PURPOSE : tells us how severely the brain has been damaged. We can assess responsiveness to therapy (if we are giving meds to decrase ICP, we can see right away other than waiting for symptoms). Backs up our assessment. Placed after brain surgery (monitoring after surgery). Some
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  • Fall '18
  • Traumatic brain injury

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