Stroke Assessment and Symptoms

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Questions and Answers

What is the primary purpose of reporting changes in ICP to the medical team?

To determine the patient's neurological status
To monitor the patient's vital signs
To adjust the patient's medication
To assist with hemodynamic evaluations and develop a treatment plan (correct)

What is the primary goal of tier one interventions in reducing ICP?

To induce neuromuscular blockade and propofol coma
To increase diuretic therapy and fluid volume
To decrease cerebrospinal fluid drainage
To maintain normothermia and minimize systemic oxygen requirements (correct)

What is the recommended range for PaO2 in the treatment of TBI?

Between 60-80 mm Hg
Between 40-60 mm Hg
< 80 mm Hg
> 100 mm Hg (correct)

What is the effect of high ICP on cerebral perfusion pressure (CPP)?

CPP decreases (D) Signup and view all the answers

What is the purpose of promoting venous return in optimizing CCP?

To prevent blood from pooling in the brain (C) Signup and view all the answers

What type of skull fracture is associated with minor traumatic injury and can heal without surgical intervention?

Linear fracture (A) Signup and view all the answers

What is the primary concern with scalp injuries?

Risk of infection (D) Signup and view all the answers

What is the primary mechanism of injury in TBI that causes damage to brain tissue due to rotational force?

Rotational (C) Signup and view all the answers

What is the name of the type of fracture where the bone is broken and pushed inward, usually requiring surgical repair?

Depressed fracture (C) Signup and view all the answers

What is the term for the fracture of one of the bones making up the base of the skull?

Basilar fracture (A) Signup and view all the answers

What is the name of the type of hematoma that occurs between the dura mater and the arachnoid mater?

Subdural hematoma (C) Signup and view all the answers

What is the term for the bruising of soft tissue in the brain?

Contusion (B) Signup and view all the answers

What is the term for a mild traumatic brain injury, often caused by blunt trauma?

Concussion (C) Signup and view all the answers

What is the term for the bleeding into the space between the arachnoid layer of the meninges and the brain?

Subarachnoid hemorrhage (A) Signup and view all the answers

What is the term for the rotation or high-speed acceleration/deceleration injury that causes widespread shearing of axons and blood vessels in the white matter?

Diffuse axonal injury (D) Signup and view all the answers

What is the term for the type of injury where the brain function is affected in several areas?

Diffuse head injury (D) Signup and view all the answers

What is the term for the accumulation of blood in the parenchyma of the brain tissue?

Intraparenchymal hematoma (D) Signup and view all the answers

What is the term for the type of fracture that requires frequent respiratory and neurological checks, as well as pain management and antibiotic treatment?

Open fracture (D) Signup and view all the answers

What is a common symptom of a possible stroke?

Sudden severe headache with no cause (B) Signup and view all the answers

What is the purpose of the Cincinnati Prehospital Stroke Scale?

To evaluate facial droop, arm drift, and speech (D) Signup and view all the answers

What is the NIH Stroke Scale used for?

To measure the severity of neurological dysfunction (D) Signup and view all the answers

What is the goal for blood glucose management in the first 48 hours post-stroke?

To avoid dextrose infusions and consider insulin infusion if BG > 200 (A) Signup and view all the answers

What is the CHA2DS2VASc scale used for?

To determine the need for anticoagulants (C) Signup and view all the answers

What is the gold standard for diagnosing brain vascular lesions, dissections, and areas of infarction?

MRI (B) Signup and view all the answers

What is the purpose of TEE in stroke diagnosis?

To identify cardiac source for embolic stroke (B) Signup and view all the answers

Why is the patient kept NPO until speech evaluation?

To prevent aspiration (B) Signup and view all the answers

What is the primary goal of carotid endarterectomy?

To increase cerebral blood flow to the ischemic area (C) Signup and view all the answers

What is the most common cause of hemorrhagic stroke?

Hypertension (B) Signup and view all the answers

What should be avoided in the treatment of hemorrhagic stroke?

Anticoagulants (C) Signup and view all the answers

What is the purpose of 'triple H therapy' in post-op complications?

To prevent cerebral vasospasm (A) Signup and view all the answers

What is the characteristic of intracerebral hemorrhagic stroke?

Bleeding directly into the brain parenchyma (B) Signup and view all the answers

What is the most common warning sign of a stroke?

Sudden weakness in the face, arm, and leg (D) Signup and view all the answers

What is the risk factor for stroke that doubles after the age of 55?

Age (A) Signup and view all the answers

What is the primary goal of early detection in managing delirium?

To identify the underlying cause of delirium (D) Signup and view all the answers

What is the purpose of craniotomy in hemorrhagic stroke?

To relieve brainstem compression (D) Signup and view all the answers

What is the recommended approach to treating patients with delirium?

Reorienting and reassuring the patient, while reducing sensory stimuli (D) Signup and view all the answers

What is the common cause of subarachnoid hemorrhagic stroke?

Cerebral aneurysm (B) Signup and view all the answers

What is the purpose of labetalol in hemorrhagic stroke treatment?

To reduce blood pressure (B) Signup and view all the answers

What is the key difference between delirium and dementia?

Delirium is reversible, while dementia is not (D) Signup and view all the answers

What is the significance of the CAM-ICU scale in managing delirium?

It is used for early detection of delirium (B) Signup and view all the answers

What is the primary goal of catastrophic brain injury guidelines?

To maintain respiratory function and prevent complications (C) Signup and view all the answers

What is the significance of decorticate posturing in patients with brain injury?

It is a sign of abnormal flexion and cerebral hemisphere dysfunction (C) Signup and view all the answers

What is the criterion for identifying potential organ donors in patients with severe brain injury?

Loss of two or more brain stem reflexes (B) Signup and view all the answers

What is the recommended approach to preventing delirium in patients?

Removing indwelling catheters and mechanical ventilation as early as possible (A) Signup and view all the answers

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Study Notes

ICP Management

Report any changes in ICP to the medical team and assist with neurological and hemodynamic evaluations
Leveled approaches to reducing ICP:
- Tier One: patient positioning strategies, normothermia maintenance, CSF drainage, and minimization of systemic oxygen requirements
- Tier Two: diuretic therapy (mannitol), fluid volume maintenance, hypertonic saline therapy (usually 3%), and PaCO2 manipulation
- Tier Three: neuromuscular blockade, propofol or barbiturate coma, and decompressive craniectomy

TBI Parameters for Treatment

ABGs: PaO2 > 100 mmHg, PaCO2 between 35-40 mmHg
BP: SBP > 90 mmHg
MAP: >65 (prefer 70)
Cerebral perfusion pressure (CPP): >70 mmHg
ICP: <20 mmHg (prefer 15)
Maintain normal body temperature or induced hypothermia (91.4-98.6°F)

Cerebral Perfusion Pressure (CPP)

Normal range: 70-100 mmHg
Decreases when MAP is low or ICP is high, and increases when ICP is low or MAP is high

Mechanisms of Injury - TBI

Acceleration/deceleration (coup/contrecoup)
Rotational
Penetrating

Scalp Injury

Minor head trauma that bleeds profusely
May result in abrasion, contusion, laceration, or hematoma
High risk of infection; must irrigate area before suturing

Skull Fracture

Occurs due to substantial force exerted on the skull with possible underlying brain tissue injury
Types:
- Linear: associated with minor traumatic injury, diagnosed with CT head, and heals over time without surgical intervention
- Depressed: may be visible and palpable, may tear meninges and extend to brain tissue, and requires surgical repair of fracture or evacuation of hematoma
- Open: depressed fracture with scalp laceration, requires possible wound I&D or surgical repair
- Basilar: fracture of one of the bones making up the base of the skull, characterized by periorbital edema, mastoid ecchymosis, CSF drainage, and facial nerve paralysis

Focal Head Injury: Cerebral Hematoma

Occurs in a well-defined area of the brain
May be the result of hematomas:
- Epidural
- Subdural
- Intraparenchymal
- Hematoma
Epidural Hematoma (EDH): high-impact shear, accumulation of blood between skull and dura mater, brief loss of consciousness followed by alertness and then brief loss of consciousness again
Subdural Hematoma (SDH): blood between dura and arachnoid, usually related to venous injury, slower onset of symptoms
Intraparenchymal Hematoma (ICH): accumulation of blood in parenchyma of brain tissue, results from uncontrolled hypertension, ruptured aneurysm, or trauma with high-impact blow to the head

Contusion and Diffuse Head Injury

Contusion: bruising of soft tissue in the brain, can begin as local injury and progress to diffuse injury
Diffuse Head Injury:
- Occurs in several areas of the brain
- Transient loss of brain function
- Concussion: mild traumatic brain injury (blunt trauma)
- Diffuse axonal injury: widespread shearing of axons and blood vessels in the white matter, rotational injury or high-speed acceleration/deceleration injury

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