95 Questions
What is the goal serum osmolarity for hyperosmolar therapy?
300-320
Which solution is used to induce hypernatremia for increasing cerebral perfusion pressures and decreasing ICP?
3% Saline
What is the recommended systolic blood pressure (SBP) to be maintained to ensure adequate mean arterial pressure (MAP) in brain injury management?
>90mmHg
Which respiratory support measure increases the mean airway pressure and decreases the MAP and CPP?
PEEP
Which CNS depressant is recommended for lowering ICP by reducing metabolic demand and relieving anxiety and pain?
Short-acting opioids
What is recommended for monitoring changes in intracranial pressure (ICP) in patients with severe brain injury?
ICP monitoring
How is any change in volume within the inflexible skull reflected?
As a change in pressure
What may cause injury if the cerebral perfusion pressure (CPP) falls below 90mmHg?
A GCS of 90mmHg
What is the appropriate intervention for hypoglycemia in the context of motor responses to pain?
Dextrose 50%
Which medication is recommended for seizure prophylaxis regardless of seizure history?
IV Keppra
What is a sign of head trauma that can be identified during a focused physical assessment?
Raccoon eyes
What is the range for reflex grading that indicates a brisk response and evidence of disease?
4+
Which type of cerebral edema is characterized by swelling of individual neurons and endothelial cells?
Cytotoxic edema
How is any change in volume within the inflexible skull reflected?
As a change in pressure
What is recommended for monitoring changes in intracranial pressure (ICP) in patients with severe brain injury?
ICP monitoring
What may cause injury if the cerebral perfusion pressure (CPP) falls below 90mmHg?
90mmHg may cause injury
What is the most common cause of death during an accident related to head injury?
Acceleration-deceleration/Coup-Countercoup
What is the lowest score possible on the Glasgow Coma Scale, consistent with brain death?
3
What is an indicator of mortality in head injury patients?
AVOID DEXTROSE (D5W)
What does fixed and dilated pupils usually indicate in the context of head injury?
Brainstem injury
What is the primary injury in head injury characterized by?
Direct injury to the parenchyma
What is the primary injury in head injury characterized by?
Direct injury to the parenchyma
What is the lowest score possible on the Glasgow Coma Scale, consistent with brain death?
3
What is the most common cause of death during an accident related to head injury?
Axons being sheared from cell bodies
What is an indicator of mortality in head injury patients?
Hypoxia
What is the appropriate intervention for hypoglycemia in the context of head injury?
Avoid dextrose (D5W)
Which medication is recommended for seizure prophylaxis regardless of seizure history?
Levetiracetam
What is the goal serum osmolarity for hyperosmolar therapy?
300-320 mOsm/L
Which type of cerebral edema is characterized by swelling of individual neurons and endothelial cells?
Cytotoxic Edema
What does fixed and dilated pupils usually indicate in the context of head injury?
Increased intracranial pressure
What is the range for reflex grading that indicates a brisk response and evidence of disease?
4+
What is the recommended goal serum osmolarity for hyperosmolar therapy in brain injury management?
300-320
Which solution is used to induce hypernatremia for increasing cerebral perfusion pressures and decreasing ICP?
3% Saline
What is the recommended range for systolic blood pressure (SBP) to be maintained to ensure adequate mean arterial pressure (MAP) in brain injury management?
>90mmHg
Which CNS depressant is recommended for lowering ICP by reducing metabolic demand and relieving anxiety and pain?
Opioid sedatives
What is the appropriate intervention to monitor changes in intracranial pressure (ICP) in patients with severe brain injury?
Elevating head of bed (HOB)
What type of solution is recommended for fluid resuscitation during the resuscitation phase?
Isotonic, hypotonic & hypertonic solutions
What is used as a rapid volume expander for fluid resuscitation?
Colloids
What is recommended for placement during the resuscitation phase to monitor urinary output?
Urinary catheter
What is the primary purpose of hypertonic agents in brain injury management?
To increase cerebral perfusion pressures and decrease ICP
What is the recommended range for systolic blood pressure (SBP) to be maintained to ensure adequate mean arterial pressure (MAP) in brain injury management?
80-90 mmHg
Which CNS depressant is recommended for lowering ICP by reducing metabolic demand and relieving anxiety and pain?
Midazolam
What is the first priority in the primary survey for a burn patient?
Manage airway
What is the leading cause of fire-related death in the context of burn injuries?
Inhalation injury
What are the clinical signs and symptoms related to central nervous system and heart in carbon monoxide (CO) poisoning at 20% HbCO?
Headache, nausea/vomiting, dyspnea on exertion
What is the treatment for Carbon monoxide (CO) poisoning to prevent neuronal death?
Methylene blue dye
What is the normal level of HbCO in the context of Carbon monoxide (CO) poisoning?
Less than 2%
What should be administered to a patient with suspected carbon monoxide poisoning?
100% oxygen
What is the leading cause of death in the context of fire-related injuries?
Inhalation injury
Which condition destroys neurons in the brain in the context of Carbon monoxide (CO) poisoning?
Delayed Encephalopathy after Carbon Monoxide Poisoning (DEACMP)
What is the range at which clinical signs and symptoms related to central nervous system and heart appear in carbon monoxide (CO) poisoning?
30% - headache, nausea/vomiting, dyspnea on exertion
What is the immediate treatment for carbon monoxide poisoning?
Administer 100% oxygen
What is the primary survey in the management of burns?
Starts at first contact
What is the goal of treatment in the management of burns?
Manage fluids, manage airway, nutritional needs
What is the recommended medication for seizure prophylaxis in trauma patients, regardless of seizure history?
Levetiracetam
What is the primary purpose of IV push Lorazepam and Valium in the context of active seizures?
To terminate the seizure activity
Which type of cerebral edema is characterized by disruption in blood-brain barriers?
Vasogenic edema
What is the range for reflex grading that indicates no response and evidence of disease or electrolyte imbalance?
0
What is the function of the amygdala in the context of the brain anatomy?
Emotional processing
What is a risk factor for thyroid storm?
Infection
What medication is used to block the peripheral effects of thyroid hormone in thyroid storm?
Propranolol
What is the pharmacologic management for myxedema coma?
Levothyroxine or thyroid hormone, glucocorticoids, fluid and electrolyte replacement
What is the primary type of rejection that occurs within the first few months after transplantation?
Acute rejection
Which medication is used for the prophylaxis of rejection, monitored by trough levels, and can cause renal dysfunction, hyperglycemia, and tremors?
Tacrolimus (Prograf)
What is the primary function of induction therapy in transplantation?
Delay the onset of the first rejection episode
Which medication blocks the proliferative phase of acute cellular rejection by inhibiting DNA synthesis?
Mycophenolate mofetil (Cellcept)
What is the consequence of chronic rejection in transplantation?
Vascular sclerosis and eventual graft loss
What is the pharmacologic manipulation of the immune system performed to prevent or suppress rejection called?
Immunosuppression
What is the leading cause of death in heart recipients?
Cardiac Allograft Vasculopathy (CAV)
What is a complication of heart transplant related to altered response to cardiovascular drugs?
Denervation
What may be observed on the ECG of a heart transplant recipient due to the transplantation process?
2 P-waves due to 2 SA nodes
Which type of heart failure may necessitate a heart transplant?
End stage heart failure refractory to medications without multi-organ failure
What is the pathogenesis of Cardiac Allograft Vasculopathy (CAV) in heart recipients?
Distinct from atherosclerotic disease
What is the primary purpose of hormone replacement therapy in hemodynamically unstable donors?
To support organ perfusion
What is the recommended time frame for implanting kidneys after x-clamp?
Implanted within 24-36 hours
In the context of ischemic times, when should hearts be implanted after x-clamp?
Implanted within 4 hours
What is the primary purpose of using Lidocaine or Amiodarone in the context of donor management?
To treat ventricular arrhythmias
What is the goal for maintaining hemoglobin (Hgb) level in hemodynamically unstable donors?
Maintain Hgb > 10 g/dL
Which of the following are contraindications for heart transplantation?
History of drug or alcohol abuse
What is a requirement for heart donors in transplantation?
ABO blood group compatibility
What is a long-term consideration for liver transplantation?
Hypertension
What is a requirement for hematopoietic stem cell transplantation donors?
ABO blood group compatibility
What is a focus of nursing care for post-transplant patients?
Preventing infection and rejection
What is the primary cause of dilutional hyponatremia in Syndrome of Inappropriate ADH (SIADH)?
Excess Anti-Diuretic Hormone (ADH)
Which medication is used to increase renal water excretion in the management of SIADH?
Demeclocycline
What is the recommended maximal rate of correction of serum sodium in the management of SIADH over the first 48 hours?
1–2mEq/L per h
What is the leading cause of death in solid organ recipients?
Infections
What is the primary factor determining mortality risk post-transplant?
Infections
What is the most common complication experienced by solid organ recipients?
Hypertension
What is the primary cause of Syndrome of Inappropriate ADH (SIADH)?
Trauma
What are the clinical manifestations of SIADH?
Lethargy, anorexia, and mental confusion
What is the goal of treatment for SIADH?
Reasonable correction parameters consist of a maximal rate of correction of serum sodium in the range of 1–2mEq/L per h as long as the total magnitude of correction does not exceed 25 mEq/L over the first 48 h
What is the leading cause of death in solid organ recipients?
Infections
Which factor may prevent a solid organ transplant from taking place?
ABO Incompatibility
What is a common complication experienced by solid organ recipients?
Hypertension
Study Notes
Neurological Assessment and Management in Trauma
- Motor Responses to Pain: Dextrose 50% for hypoglycemia, Oxygen 100% for hypoxemia, Naloxone for narcotic-induced pinpoint pupils, Thiamine w/ fluids for alcohol withdrawal.
- Seizure Prophylaxis: IV Keppra regardless of seizure history, IV push Lorazepam and Valium for active seizures, intubation and propofol drip for status epilepticus.
- Focused Physical Assessment: Identifying signs of head trauma like Battle's sign, raccoon eyes, scalp lacerations, Babinski reflex, and cranial nerve function.
- Reflex Grading: Ranging from 4+ (brisk response, evidence of disease) to 0 (no response, evidence of disease or electrolyte imbalance).
- Anatomy of the Brain: Functions of frontal, parietal, temporal, and occipital lobes, cerebellum, brainstem, and amygdala.
- Intracranial Pressure: Monro-Kellie Hypothesis, clinical manifestations, and autoregulation to maintain cerebral perfusion pressure.
- Cerebral Blood Flow: Regulation by mean arterial pressure (MAP), effects of acidosis, alkalosis, and metabolic changes, and leading causes of cerebral ischemia.
- Cerebral Edema Types: Vasogenic edema (disruption in blood-brain barriers) and cytotoxic edema (swelling of individual neurons and endothelial cells).
Neurological Assessment and Management in Trauma
- Motor Responses to Pain: Dextrose 50% for hypoglycemia, Oxygen 100% for hypoxemia, Naloxone for narcotic-induced pinpoint pupils, Thiamine w/ fluids for alcohol withdrawal.
- Seizure Prophylaxis: IV Keppra regardless of seizure history, IV push Lorazepam and Valium for active seizures, intubation and propofol drip for status epilepticus.
- Focused Physical Assessment: Identifying signs of head trauma like Battle's sign, raccoon eyes, scalp lacerations, Babinski reflex, and cranial nerve function.
- Reflex Grading: Ranging from 4+ (brisk response, evidence of disease) to 0 (no response, evidence of disease or electrolyte imbalance).
- Anatomy of the Brain: Functions of frontal, parietal, temporal, and occipital lobes, cerebellum, brainstem, and amygdala.
- Intracranial Pressure: Monro-Kellie Hypothesis, clinical manifestations, and autoregulation to maintain cerebral perfusion pressure.
- Cerebral Blood Flow: Regulation by mean arterial pressure (MAP), effects of acidosis, alkalosis, and metabolic changes, and leading causes of cerebral ischemia.
- Cerebral Edema Types: Vasogenic edema (disruption in blood-brain barriers) and cytotoxic edema (swelling of individual neurons and endothelial cells).
Solid Organ Transplant: Key Points
- Definitions: Donor, Recipient, Calcineurin, T-cells, B-cells, HLA, ABO Incompatibility
- Risk of Mortality Post-Transplant: Factors determining mortality risk
- Absolute and Relative Contraindications: Factors that may prevent solid organ transplant
- Common Complications: Hypertension, Post-Transplant Diabetes Mellitus, Renal Insufficiency, Hyperlipidemia, Myopathy, Bone Disease, Malignancy
- Post-Transplant Diabetes Mellitus: Incidence, causes, treatment options
- Renal Insufficiency: Causes and management
- Hyperlipidemia: Occurrence, contribution to disease, and treatment
- Bone Disease: Osteoporosis, prevention, and treatment
- Malignancy: Increased incidence and associated risks
- Infections: Leading cause of death in solid organ recipients, types and prophylaxis
- Rejection: Types, causes, and consequences
- Fungal and Bacterial Infections: Types, causes, and prevalence in different transplant recipients
Test your knowledge of neurological assessment and management in trauma with this quiz. Explore topics such as motor responses to pain, seizure prophylaxis, focused physical assessment, reflex grading, brain anatomy, intracranial pressure, cerebral blood flow regulation, and cerebral edema types.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
