HESI Critical Care Cardiac Neuro.pdf

Phenytoin levetiracetam keppra new preferred

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Phenytoin Levetiracetam (Keppra): new preferred antseizure meds especially if pt doesn’t have hx of seizures. 4. Neuromuscular blockade: paralyze patients. Can be done but not common. LAST thing that you want to do (this is because it almost completely reduces the metabolic demands and lets the body rest) Surgical Interventions May be required to remove the cause of the IICP Decompressive hemicraniectomy: take part of skull and remove it; allows brain to swell like it wants to. Take bone flap and put it in subcutaneous pocket on body. -May be performed for severe injury Psychosocial Support Patient Family: a lot for family bc pt is sedated or paralyzed -Support -Information -Chaplain or social services
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Critical Care Test 3 (5) Traumatic Brain Injury Skull Fractures Traumatic Brain Injury Classifications 1. Open vs Closed Open: brain is exposed 2. Linear skull fracture Basilar skull fracture: battle sign. raccoon eyes Rhinorrhea/Ottorrhea: no packing in nose or ears. Want it draining to decrease ICP. If you plug it up, CSF will not drain and ICP will increase. Halo Sign (checks if CSF): take piece of gauze. It’ll separate. Blood in middle. CSF outside. No NG tube 3. Depressed skull fracture 4. Comminuted skull fracture Primary Direct injury to brain tissue Coup/Contrecoup Injury: anything causing brain to rattle in skull. Whiplash moment; brain flies forward and back. Types Concussion (most common): typically affects frontal lobe. Pts can become totally different people. Frontal lobe damage can change judgment, personality, etc. Problem: nothing shows up on CT. It is based on symptoms (n/v, HA). Treatment is to rest brain. Contusion: bruises of brain Seen with leaking blood vessels. Penetrating injuries: bullets, knives, ice picks, arrows Diffuse axonal injuries (most severe): involve tearing or stretching of nerve fibers at axon. Common causes: shaking (shaken baby syndrome). Hematomas Epidural (B): caused by bleeding arteries. Pt will lose consciousness at time of injury but quickly regain consciousness. Pt will quickly deteriorate. Subdural (A): caused by bleeding veins. Acute (loss of consciousness, worsening symptoms) vs Chronic (seen in elderly, brain has shrunk (shrinks as you age) more room in skull for blood to collect; develop slowly) Intracerebral: bleeding in brain tissue itself. Secondary to trauma or ruptured aneurysms. Complications of primary injury : Intracranial bleeding Secondary : body’s response to primary injury Consequence of initial trauma Inflammatory response: causes vasodilation and capillary permeability. Inflammation leads to cerebral edema. Release of cytokines: Vasogenic edema Loss of Autoregulation Traumatic Brain Injury Management Nursing: same as ICP 1. Hourly Neurological assessment: Glasgow Coma Scale 2. Hourly Airway assessment 3. ICP monitoring 4. Hemodynamic monitoring 5. Interventions to control elevated ICP 6. Evaluation of diagnostic tests 7. Caut ious with suctioning. Look for cushing’s triad.
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  • Fall '18
  • Traumatic brain injury

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