Neurological Assessment and Management in Trauma Quiz
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Questions and Answers

What is the goal serum osmolarity for hyperosmolar therapy?

  • 250-280
  • 200-220
  • 350-380
  • 300-320 (correct)

    • Which solution is used to induce hypernatremia for increasing cerebral perfusion pressures and decreasing ICP?

  • Lactated Ringer's solution
  • 5% Dextrose
  • 3% Saline (correct)
  • 0.9% Saline (Normal Saline)

    • What is the recommended systolic blood pressure (SBP) to be maintained to ensure adequate mean arterial pressure (MAP) in brain injury management?

  • >120mmHg
  • >140mmHg
  • >90mmHg (correct)
  • >60mmHg

    • Which respiratory support measure increases the mean airway pressure and decreases the MAP and CPP?

    <p>PEEP</p> Signup and view all the answers

    Which CNS depressant is recommended for lowering ICP by reducing metabolic demand and relieving anxiety and pain?

    <p>Short-acting opioids</p> Signup and view all the answers

    What is recommended for monitoring changes in intracranial pressure (ICP) in patients with severe brain injury?

    <p>ICP monitoring</p> Signup and view all the answers

    How is any change in volume within the inflexible skull reflected?

    <p>As a change in pressure</p> Signup and view all the answers

    What may cause injury if the cerebral perfusion pressure (CPP) falls below 90mmHg?

    <p>A GCS of 90mmHg</p> Signup and view all the answers

    What is the appropriate intervention for hypoglycemia in the context of motor responses to pain?

    <p>Dextrose 50%</p> Signup and view all the answers

    Which medication is recommended for seizure prophylaxis regardless of seizure history?

    <p>IV Keppra</p> Signup and view all the answers

    What is a sign of head trauma that can be identified during a focused physical assessment?

    <p>Raccoon eyes</p> Signup and view all the answers

    What is the range for reflex grading that indicates a brisk response and evidence of disease?

    <p>4+</p> Signup and view all the answers

    Which type of cerebral edema is characterized by swelling of individual neurons and endothelial cells?

    <p>Cytotoxic edema</p> Signup and view all the answers

    How is any change in volume within the inflexible skull reflected?

    <p>As a change in pressure</p> Signup and view all the answers

    What is recommended for monitoring changes in intracranial pressure (ICP) in patients with severe brain injury?

    <p>ICP monitoring</p> Signup and view all the answers

    What may cause injury if the cerebral perfusion pressure (CPP) falls below 90mmHg?

    <p>90mmHg may cause injury</p> Signup and view all the answers

    What is the most common cause of death during an accident related to head injury?

    <p>Acceleration-deceleration/Coup-Countercoup</p> Signup and view all the answers

    What is the lowest score possible on the Glasgow Coma Scale, consistent with brain death?

    <p>3</p> Signup and view all the answers

    What is an indicator of mortality in head injury patients?

    <p>AVOID DEXTROSE (D5W)</p> Signup and view all the answers

    What does fixed and dilated pupils usually indicate in the context of head injury?

    <p>Brainstem injury</p> Signup and view all the answers

    What is the primary injury in head injury characterized by?

    <p>Direct injury to the parenchyma</p> Signup and view all the answers

    What is the primary injury in head injury characterized by?

    <p>Direct injury to the parenchyma</p> Signup and view all the answers

    What is the lowest score possible on the Glasgow Coma Scale, consistent with brain death?

    <p>3</p> Signup and view all the answers

    What is the most common cause of death during an accident related to head injury?

    <p>Axons being sheared from cell bodies</p> Signup and view all the answers

    What is an indicator of mortality in head injury patients?

    <p>Hypoxia</p> Signup and view all the answers

    What is the appropriate intervention for hypoglycemia in the context of head injury?

    <p>Avoid dextrose (D5W)</p> Signup and view all the answers

    Which medication is recommended for seizure prophylaxis regardless of seizure history?

    <p>Levetiracetam</p> Signup and view all the answers

    What is the goal serum osmolarity for hyperosmolar therapy?

    <p>300-320 mOsm/L</p> Signup and view all the answers

    Which type of cerebral edema is characterized by swelling of individual neurons and endothelial cells?

    <p>Cytotoxic Edema</p> Signup and view all the answers

    What does fixed and dilated pupils usually indicate in the context of head injury?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What is the range for reflex grading that indicates a brisk response and evidence of disease?

    <p>4+</p> Signup and view all the answers

    What is the recommended goal serum osmolarity for hyperosmolar therapy in brain injury management?

    <p>300-320</p> Signup and view all the answers

    Which solution is used to induce hypernatremia for increasing cerebral perfusion pressures and decreasing ICP?

    <p>3% Saline</p> Signup and view all the answers

    What is the recommended range for systolic blood pressure (SBP) to be maintained to ensure adequate mean arterial pressure (MAP) in brain injury management?

    <p>&gt;90mmHg</p> Signup and view all the answers

    Which CNS depressant is recommended for lowering ICP by reducing metabolic demand and relieving anxiety and pain?

    <p>Opioid sedatives</p> Signup and view all the answers

    What is the appropriate intervention to monitor changes in intracranial pressure (ICP) in patients with severe brain injury?

    <p>Elevating head of bed (HOB)</p> Signup and view all the answers

    What type of solution is recommended for fluid resuscitation during the resuscitation phase?

    <p>Isotonic, hypotonic &amp; hypertonic solutions</p> Signup and view all the answers

    What is used as a rapid volume expander for fluid resuscitation?

    <p>Colloids</p> Signup and view all the answers

    What is recommended for placement during the resuscitation phase to monitor urinary output?

    <p>Urinary catheter</p> Signup and view all the answers

    What is the primary purpose of hypertonic agents in brain injury management?

    <p>To increase cerebral perfusion pressures and decrease ICP</p> Signup and view all the answers

    What is the recommended range for systolic blood pressure (SBP) to be maintained to ensure adequate mean arterial pressure (MAP) in brain injury management?

    <p>80-90 mmHg</p> Signup and view all the answers

    Which CNS depressant is recommended for lowering ICP by reducing metabolic demand and relieving anxiety and pain?

    <p>Midazolam</p> Signup and view all the answers

    What is the first priority in the primary survey for a burn patient?

    <p>Manage airway</p> Signup and view all the answers

    What is the leading cause of fire-related death in the context of burn injuries?

    <p>Inhalation injury</p> Signup and view all the answers

    What are the clinical signs and symptoms related to central nervous system and heart in carbon monoxide (CO) poisoning at 20% HbCO?

    <p>Headache, nausea/vomiting, dyspnea on exertion</p> Signup and view all the answers

    What is the treatment for Carbon monoxide (CO) poisoning to prevent neuronal death?

    <p>Methylene blue dye</p> Signup and view all the answers

    What is the normal level of HbCO in the context of Carbon monoxide (CO) poisoning?

    <p>Less than 2%</p> Signup and view all the answers

    What should be administered to a patient with suspected carbon monoxide poisoning?

    <p>100% oxygen</p> Signup and view all the answers

    What is the leading cause of death in the context of fire-related injuries?

    <p>Inhalation injury</p> Signup and view all the answers

    Which condition destroys neurons in the brain in the context of Carbon monoxide (CO) poisoning?

    <p>Delayed Encephalopathy after Carbon Monoxide Poisoning (DEACMP)</p> Signup and view all the answers

    What is the range at which clinical signs and symptoms related to central nervous system and heart appear in carbon monoxide (CO) poisoning?

    <p>30% - headache, nausea/vomiting, dyspnea on exertion</p> Signup and view all the answers

    What is the immediate treatment for carbon monoxide poisoning?

    <p>Administer 100% oxygen</p> Signup and view all the answers

    What is the primary survey in the management of burns?

    <p>Starts at first contact</p> Signup and view all the answers

    What is the goal of treatment in the management of burns?

    <p>Manage fluids, manage airway, nutritional needs</p> Signup and view all the answers

    What is the recommended medication for seizure prophylaxis in trauma patients, regardless of seizure history?

    <p>Levetiracetam</p> Signup and view all the answers

    What is the primary purpose of IV push Lorazepam and Valium in the context of active seizures?

    <p>To terminate the seizure activity</p> Signup and view all the answers

    Which type of cerebral edema is characterized by disruption in blood-brain barriers?

    <p>Vasogenic edema</p> Signup and view all the answers

    What is the range for reflex grading that indicates no response and evidence of disease or electrolyte imbalance?

    <p>0</p> Signup and view all the answers

    What is the function of the amygdala in the context of the brain anatomy?

    <p>Emotional processing</p> Signup and view all the answers

    What is a risk factor for thyroid storm?

    <p>Infection</p> Signup and view all the answers

    What medication is used to block the peripheral effects of thyroid hormone in thyroid storm?

    <p>Propranolol</p> Signup and view all the answers

    What is the pharmacologic management for myxedema coma?

    <p>Levothyroxine or thyroid hormone, glucocorticoids, fluid and electrolyte replacement</p> Signup and view all the answers

    What is the primary type of rejection that occurs within the first few months after transplantation?

    <p>Acute rejection</p> Signup and view all the answers

    Which medication is used for the prophylaxis of rejection, monitored by trough levels, and can cause renal dysfunction, hyperglycemia, and tremors?

    <p>Tacrolimus (Prograf)</p> Signup and view all the answers

    What is the primary function of induction therapy in transplantation?

    <p>Delay the onset of the first rejection episode</p> Signup and view all the answers

    Which medication blocks the proliferative phase of acute cellular rejection by inhibiting DNA synthesis?

    <p>Mycophenolate mofetil (Cellcept)</p> Signup and view all the answers

    What is the consequence of chronic rejection in transplantation?

    <p>Vascular sclerosis and eventual graft loss</p> Signup and view all the answers

    What is the pharmacologic manipulation of the immune system performed to prevent or suppress rejection called?

    <p>Immunosuppression</p> Signup and view all the answers

    What is the leading cause of death in heart recipients?

    <p>Cardiac Allograft Vasculopathy (CAV)</p> Signup and view all the answers

    What is a complication of heart transplant related to altered response to cardiovascular drugs?

    <p>Denervation</p> Signup and view all the answers

    What may be observed on the ECG of a heart transplant recipient due to the transplantation process?

    <p>2 P-waves due to 2 SA nodes</p> Signup and view all the answers

    Which type of heart failure may necessitate a heart transplant?

    <p>End stage heart failure refractory to medications without multi-organ failure</p> Signup and view all the answers

    What is the pathogenesis of Cardiac Allograft Vasculopathy (CAV) in heart recipients?

    <p>Distinct from atherosclerotic disease</p> Signup and view all the answers

    What is the primary purpose of hormone replacement therapy in hemodynamically unstable donors?

    <p>To support organ perfusion</p> Signup and view all the answers

    What is the recommended time frame for implanting kidneys after x-clamp?

    <p>Implanted within 24-36 hours</p> Signup and view all the answers

    In the context of ischemic times, when should hearts be implanted after x-clamp?

    <p>Implanted within 4 hours</p> Signup and view all the answers

    What is the primary purpose of using Lidocaine or Amiodarone in the context of donor management?

    <p>To treat ventricular arrhythmias</p> Signup and view all the answers

    What is the goal for maintaining hemoglobin (Hgb) level in hemodynamically unstable donors?

    <p>Maintain Hgb &gt; 10 g/dL</p> Signup and view all the answers

    Which of the following are contraindications for heart transplantation?

    <p>History of drug or alcohol abuse</p> Signup and view all the answers

    What is a requirement for heart donors in transplantation?

    <p>ABO blood group compatibility</p> Signup and view all the answers

    What is a long-term consideration for liver transplantation?

    <p>Hypertension</p> Signup and view all the answers

    What is a requirement for hematopoietic stem cell transplantation donors?

    <p>ABO blood group compatibility</p> Signup and view all the answers

    What is a focus of nursing care for post-transplant patients?

    <p>Preventing infection and rejection</p> Signup and view all the answers

    What is the primary cause of dilutional hyponatremia in Syndrome of Inappropriate ADH (SIADH)?

    <p>Excess Anti-Diuretic Hormone (ADH)</p> Signup and view all the answers

    Which medication is used to increase renal water excretion in the management of SIADH?

    <p>Demeclocycline</p> Signup and view all the answers

    What is the recommended maximal rate of correction of serum sodium in the management of SIADH over the first 48 hours?

    <p>1–2mEq/L per h</p> Signup and view all the answers

    What is the leading cause of death in solid organ recipients?

    <p>Infections</p> Signup and view all the answers

    What is the primary factor determining mortality risk post-transplant?

    <p>Infections</p> Signup and view all the answers

    What is the most common complication experienced by solid organ recipients?

    <p>Hypertension</p> Signup and view all the answers

    What is the primary cause of Syndrome of Inappropriate ADH (SIADH)?

    <p>Trauma</p> Signup and view all the answers

    What are the clinical manifestations of SIADH?

    <p>Lethargy, anorexia, and mental confusion</p> Signup and view all the answers

    What is the goal of treatment for SIADH?

    <p>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</p> Signup and view all the answers

    What is the leading cause of death in solid organ recipients?

    <p>Infections</p> Signup and view all the answers

    Which factor may prevent a solid organ transplant from taking place?

    <p>ABO Incompatibility</p> Signup and view all the answers

    What is a common complication experienced by solid organ recipients?

    <p>Hypertension</p> Signup and view all the answers

    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

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    Description

    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.

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