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Neuro
Ugh
48
Nursing
Graduate
04/06/2015

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Cards

Term
SEPs measure what?
Definition
Ascending seonsory pathways in posterior cord and cerebral cortex
Term
3 types of SEPs
Definition
1) Somatosensory evoked potentials (SSEPs)
2) Brain Auditory Evoked Potentials (BAEPs) -for surgery near brainstem
3) Visual Evoked Potentials (VEPs)-for surgery at the base of the brain or near optic chiasm
Term
4 factors that alter amplitude/latency of SEPs
Definition
1) temp
2) decreased BP
3) PaCO2
4)PaO2
Term
GA does what to amplitude and latency of SEPs?
Definition
It decreases amplitude and prolongs latency (directly proportional)
Term
Which SEP is most sensitive to GA?
Definition
VEP (VVVery sensitive)
Term
WHich SEP is intermediately sensitive to GA?
Definition
SSEP (Somewhat sensitive)
Term
WHich SEP is lease sensitive to GA?
Definition
BAEP (Barely sensitive)
Term
Motor evoked potentials
Definition
Measure descending motor pathways in the anterior spinal cord.
Term
Jugular Bulb venous oximetry
Definition
Gives balance between cerebral O2 supply and demand by calculating O2 sat in venous IJ blood
Term
Normal SjvO2 (Jugular bulb venous oximetry)
Definition
60-70%
Term
What do you never do with a ventriculostomy
Definition
put it on a pressure bag
Term
Where do you balance a ventriculostomy drain to?
Definition
The foramen of munroe or auditory meatus
Term
ventriculostomy drainage bag is hung where?
Definition
0-20cm below the auditory meatus, if it is hung too lung it can cause ventricular collapse
Term
Fiberoptic camino ICP monitor
Definition
-Placed in the subdural space
-can check ICP, CBF, CO2, pH, and brain tissue O2 monitoring
Term
Incidence of VAEs with sitting cranies
Definition
20-40%
Term
VAEs occur when the surgical site is _____ the level of the heart
Definition
Above
Term
What is the most sensitive monitor for a VAE?
Definition
TEE
Term
What is the second most sensitive monitor for a VAE?
Definition
Doppler (detects air bubbles that are 0.25ml in size)
Term
Where do you place a doppler to check for VAE?
Definition
Right Sternum, 3-6 rib interspace
Term
What does a VAE sound like on a doppler?
Definition
"Mill Wheel" grinding sound
Term
Changes that occur with a VAE
Definition
1) decreased CO
2) decreased gas exchange
3) V/Q mismatch
4) Foramen ovale pops open and can allow air to move into the arterial system
Term
Treatment for a VAE
Definition
-flood field with saline, bone wax
-DC nitrous
-100% FiO2
-Aspirate air from CVP
-increase circ volume
-treat low BP
-head down position
-turn on left side (R atrium up)
-jugular compression
Term
If you have a multi-oriface CVP where should it be placed to aspirate for a VAE?
Definition
2-3cm below the junction of R atrium and SVC
Term
If you have a single-oriface CVP where should it be placed to aspirate for a VAE?
Definition
3CM above the junction of the R atrium and SVC
Term
Where should A-line be leveled to in sitting position?
Definition
The ear
Term
What IVF do you want to use in craniotomies?
Definition
NS
Term
Blood sugar level for craniotomies
Definition
<200 mg/dL
Term
Blood sugar reduces by how much with 1 unit of insulin?
Definition
25
Term
What are the 4 most stimulating phases of a craniotomy?
Definition
1) laryngoscopy
2) tongs
3) incision
4) opening of the dura
Term
2 most common causes of subarachnoid hemorrhage
Definition
1) aneurysm
2) AV malformation
Term
Subarachnoid hemorrhage, ____ % have myocardial ischmia due to high catecholamines
Definition
20%
Term
Insitute ICP monitoring in traumatic head injuries if GCS ___ after adequate resucitation of shock, ____ years of age, and SBP ____, and or posturing
Definition
GCS 3-8, >40, SBP <90
Term
Initiate treatment in traumatic head injury when ICP is...
Definition
20-25 mmHg
Term
Goal CPP in traumatic head injury
Definition
>60-70mmHg
Term
Vasospasm post-bleed or post-clipping occurs how many days after surgery for an aneurysm
Definition
4-14
Term
CVP, PAP goal to prevent vasospasm
Definition
CVP >12mmHg, PAP>18mmHg
Term
Other goals to prevent vasospasm
Definition
HTN, Hemodilution (HCT 30%), Ca channel blockers
Term
During temporary aneurysm clipping, what is your goal MAP?
Definition
normal-high to maintain perfusion through the circle of willis
Term
During aneurysm repair without temp clipping what is your MAP target for deliberate hypotension?
Definition
40-50 mmHg
Term
Ruptured aneurysm treatment
Definition
1) hypotension
2) aggressive fluid and blood therapy
3) cerebral protective agents (pentothal)
4) carotid compression (up to 3 minutes)
Term
Supratentorial lesions are associated with what?
Definition
difficulty managing ICP
Term
Infratentorial lesions problems with mass effect on brainstem
Definition
hemodynamic changes
arrhythmias
elevated ICP, reduces CPP
Term
Burst Suppression indications
Definition
refractory status epilepticus
refractory intracranial hypertension
intraoperative neuroprotection
Term
Burst Suppression ratio
Definition
10:1
Term
Artery of Adamkiewicz
Definition
From T-5 to L-1, arises left, supplies the anterior artery
Term
Methylprednisone dose
Definition
methylprednisone 30 mg/kg over 1 hour then 5.4 mg/kg/hr over the next 23 hours
Term
Autonomic hyper-reflexia above injury
Definition
flushing
sweating
nasal stuffiness/headache
Term
Autonomic hyper-reflexia below injury
Definition
pallor
pilomotor erection
muscle contraction/spasm
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