Session 2: Neuro

 

Session 2: Neuro

 

Spinal cord injury

 

  • Spinal cord injury patients can have lower BP’s such as 80/52
  • The issue of BP changes is when there is a large change from baseline.
  • S2,3,4 can have issues with bowel and bladder sphincter contractility
    • These are reflexes controlled in the spinal cord.
  • Spinal shock is not neurogenic shock
    • Spinal shock = spinal loss of reflexes, motor, and sensory at and below the level of injury.
      • Spinal shock is inflammation from the injury or lesion and goes away
      • Exists in the acute phase
      • No peristalsis, no voiding, need foley catheter
  • T6 and above can have autonomic dysreflexia
  • Cervical spine and above are tetraplegic and below are paraplegic
  • Injury at T12 and below is flaccid bladder
  • Injury above T12 and above is spastic bladder
  • Autonomic dysreflexia – an over reaction to something below the level of injury such as bladder distension, or a stubbed toe.
    • Above LOI vasodilation, HA, Flushed skin,  
    • Below LOI vasoconstriction, cold clammy, goose bumps, pale.

 

Stroke

 

  • Ischemic stroke – caused by loss of blood flow due to clot
    • Give TPa if within 4.5 hours of symptom onset
    • Neet CT scan to confirm Ischemic stroke
    • Excluded from TPa administration if: Head trauma or stroke in the last three months, aneurysm, active bleed, platelet count under 100,000,  INR >1.7, PT > 15 seconds. Taking warfarin, taking heparin in the last 48 hours with a high aPTT vessel

 

Epidural hemorrhage – usually ARTERIAL, FAST

Subdural hemorrhage – usually VENUS, SLOW

 

Pituitary Tumors

  • s/s – vision changes, increased ICP, DI or SIADH may be present.
  • Avoid cough, sneeze, sucking.
  • Watch for CSF leak, test leak for glucose and Halo test.
  • Surgery for this to be removed is through the nose.
  • Monitor for headache after surgery. This points toward a CSF leak.

Rosenbaum Pocket eye exam

  • An eye test on a notecard that tests each eye at an arm’s length. Make sure that the room is lit well for this test, and they have their glasses if they need them.

 

  • ICPs
    • Normal 0-10 mmhg
    • Increased is at 15 mmhg
    • Look for changes in LOC, pupils, Cushing’s triad Widening pulse pressure, bradycardia that is irregular, and irregular respiratory rate.
    • Causes – hypercapnia, hypoxemia, vasodilation

 

  • Cerebral perfusion pressure
    • The pressure that we need to perfuse the brain by overcoming the ICP.
    • >60 is normal.
    • The higher the CPP the higher the perfusion to the brain. (to a point)

 

  • Hemicraniectomy – removing a portion of the skull to allow for ICP to go down.
    • This person NEEDS a helmet when out of bed.
  • Raccoon eyes – indicative of a csf leak. Dark to black or reddish swelling under the eyes.
    • Keep HOB raised to allow the swelling to go down.


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