- Most common benign tumor

-arise from the covering of the brain

- tends to recur after removal

-highly malignant

-grows rapidly

- 18 month survival rate

-weakened area of arterial wall

-rupture results in immediate death

- VENOUS bleed

- most commonly from tearing of the bridging veins within the brain or due to laceration of brain tissue

- bleeding occurs more slowly (because it's venous bleed)

- neurosurgical emergency

- ARTERIAL bleed

-temporal bone fractures the middle cerebral artery

- symptoms progress quickly

- emotions

-impulse control

-language 

-memory

-social and sexual behavior

-inability to locate parts of your body

- inablity to recognize parts of your body

- hearing 

- language 

- ability to recognize a familiar face (sensory problems)

- vision

-distorted view of sizes, shapes and colors

- uncoordinated movement 

- loss of muscle tone

- unsteady gait

-heart rate

-breathing

-swallowing 

- enlarged ventricles requiring insertion of a ventriculo peritoneal shunt

- ventriculo = ventricles 

- peritoneal = abdomen 

- CSF is shunted into the abdomen

- Changes in LOC

- Headache

-vomiting

-papillary changes

-decrease in sensory and motor function

- Cushings Triad

-increased systolic BP and widened pulse pressure

- Bradycardia

-abnormal respirations

- oxygen

- glucose

-CO2

-alcohol

- anesthetics

-water

I

Smell

II

vision

III

Levator palpebrae, superioris, superior, medial & inferior recti muscles (muscles of the eye)

Parasympathetic to ciliary & pupillary constrictor muscles

IV

superior oblique muscle (muscle of the eye)

V

Muscles of mastication (chewing)

Sensory for head/neck, sinuses, meninges, & external surface of tympanic membrane

VI

Lateral rectus muscle

VII

Muscles of facial expression 

Parasympathetic to all glands of head except the parotid 

Sensory for ear and tympanic membrane 

Taste anterior two-thirds of tongue

VIII

hearing and balance

IX

Stylopharyngeus muscle 

Parotid Gland 

Carotid Body 

Sensation posterior one-third tongue & internal surface of tympanic membrane. 


Taste posterior one-third tongue

X

Muscles pharynx & larynx 

Parasympathetic to neck, thorax, & abdomen 

Sensory  from pharynx, larynx & viscera 

Sensory from external ear

Spinal accessory

XI

Trapezius and sternocleidomastoid muscles

(shoulders and shrugging)

XII

Tongule muscles

-dorsiflexion of the great toe and fanning of the other toes

-indicates the presence of pathology in the CNS

- can occur with intoxication or after a stroke

Preparation for MRI

Do you need consent?

Contraindications?

-no food or fluid restriction

-ask is claustrophobic 

-tell them it's noisy

No you do not need consent

contraindicated with pacemakers, other implantable devices, confused or agitated patients

between the L3 and L4 

or 

between the L4 and L5

(because that is where the spinal cord ends so you have less chance of hitting the cord)

- have them empty their bladder

-position in fetal position

-grab the back of their neck and behind their knees

-clean with chlorahexadine

- bed rest between 4-8 hours

-give lots of fluids

-if they get spinal headache, give more fluids and bed flat for 48 hours 

Increased ICP beacuse it could cause the brain to herniate

(you release the pressure and create a vaccum)

- pressure is less than 20 cm H2O

- clear and colorless

- 0-5 small lymphocytes

- 15-45 mg/dl Proteins

- 50-75 mg/dl Glucose

-linear fracture

-depressed fracture

-basilar skull fracture

- open head injury

- simple clean break

- impacted area of bone bends inward and area around it bends outward

-open head injury

-bone is pressed inward into the brain tissue to at least the thickness of the skull

-open head injury

- occurs at the base of the skull

-usually extends into the anterior, middle or posterior fossa and results in CSF leakage from nose or ears

-present with raccoon eyes and battle's sign

-mild concussion

-diffuse axonal injury

-contusion 

-laceration

The salt pump is no longer working, so the brain is going to be depleted of oxygen and glucose

anaerobic metabolism begins and salt begins to enter the cells

pt. becomes hyponatremic

seizures may occur

2 x the diastolic + the systolic

(needs to be at least 60 to perfuse the major organs)

(normal pressure is 70-110)

subdural hematoma 

(chronic)

present 2 weeks and several months

most likely in the elderly because they can accommodate the hematoma

subdural hematoma

(sub-acute)

A brain herniation is when brain tissue, cerebrospinal fluid, and blood vessels are moved or pressed away from their usual position inside the skull.

Symptoms
Cardiac arrest (no pulse)
Coma
Lethargy
Loss of all brainstem reflexes (blinking, gagging, pupils reacting to light)
Loss of consciousness
Respiratory arrest (no breathing)

-moderate to severe injury means they will most likely not return to baseline

-short term memory problems

-vocation rehab may be needed

-need a schedule that is repetitive

central fever

will not respond to tylenol

a cooling blanket and sponge bath works better

- want to prevent their CO2 from elevating (want it to be 35-38)

- need ABG levels at least once a shift or when there are ventilation changes or if their vitals change

-O2 needs to be 80-100 (prevents dilation from hypoxemia

-suction

neutral position

head between 20 and 30 degrees

- can get order for lidocaine to reduce gag reflex

- need 2 people (one to  bag and 1 to suction)

- hyperoxygenate to 100% to get ICP down

- take 1 pass and immediately bag again

-let them rest between passes

Mannitol 

morphine and fentanyl for pain

(fentanyl is better)

induction of barbiturate coma (last resort)

osmotic diuretic

-best to give in boluses

-do not give as continuous infusion

-use filtered needle

-monitor I&O's

-lasix helps it work better

decreases the demands/activity of the brain

Must give pain medication when this is done

-acetylcholinesterase inhibitor

-delays the destruction of acetycholine

-delays onset of cognitive smptoms in Alzheimer's Disease

-side effects: liver toxicity, GI upset

-monitor liver functions tests

-CNS agent

- drug of choice for status epilepticus

-monitor ABCs

-anticonvulsant

-treatment of seizures

- mix with NS only

-therapuetic level is 10-20 mgm/ml

-highly irritating to veins

-watch for gingival hyperplasia

-do not give with coumadin

anti-psychotic

-relief of agitatin

-given in Alzheimer's disease

-side effect: tremors

-benzo

-CNS agent

-administered for status epilepticus

-monitor ABCs

-anticonvulsant

-controls seizures

-side effects: drowsiness, dizziness, ataxia, GI upset

-monitor blood levels

-Vent them

-immediate decrease in ICP

-have to be weaned off

-seizures may occur

-anticonvulsants administered

-steroid

-decreases inflammation and decreases cerebral edema

- given by IV 10 mg bolus followed by 4 mg q 4 hrs

- immunosuppression occurs, increased glucose occurs

-need to taper dose

-osmotic diuretic

-decreases cerebral edema

-use filter needle, 1.5-2.0 g/kg

-monitor urine output

-neuromuscular blocking agent

-paralysis of muscles

-has no sedative or analgesic effect

-need a versed and morphine/fentenyl gtt

tachycardia

dyspnea

rales

moist respirations

cough

sweating

Sickle turbidity test

tool used to screen for sickle cell anemia using blood from a finger or heel stick

2 months

in children with SCD

iron overload

occurs with multiple tranfusions

is treated with chelation 

Meperidine

a metabolite of this drug may result in seizures

cardiac slowing center

and 

respiratory center

cardiac acceleration and vasoconstriction centers

and 

pneumotaxic center helps control respiratory pattern and rate

pupils decrease in size

touch sensation decreases (may lead to falls)

vibration sense may be lost in the ankles and feet

hearing decreases, especially high-pitched sounds

-accuracy of medical history

- dates of clinic or other appointments

- time of admission

-heath care providers seen within past few days

- how they got to the hospital

give pt. two or three unrelated words and asking them to repeat the words

after about 5 min. ask them to repeat the words

ask the pt. to repeat a series of three numbers

with each successful repetition increase the series by one up until seven or eight digits are achieved

asking the meaning of proverbs  

i.e. a rolling stone gathers no moss

abnormal posturing

the pt's arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs

abnormal posturing

the pt. extends the arms and legs, pronation of the arms, plantar flexion and opisthotonos (body spamsm in which the body is bowed forward)

- ask about allergy to iodine

- npo 4-6 hrs before test

-determine if pt. is claustrophobic (sedation may be necessary or open CT)

- remove hairpins, hairpeices or wigs

- may be loud

epidural hematoma

-dilated and nonreactive pupils

-drooping eyelids (ptosis)

-rapidly deteriorating level of consciousness

Cheyne-strokes respirations

pinpoint and nonreactive pupils

potential hemodynamic instability 

decreased GI motility 

cardiac dysrhythmias

hypotension

fluctuations in body temp

-painful episode

-most common type of non-life threatening crisis 

-characterized by ischemia causing mild to severe pain

- often migratory with presence of low grade fever

-can result in hand and foot syndrome

sequestration crisis

-caused by pooling of large quantities of blood, usually in the spleen which causes a decrease in blood volume and ultimately shock

accut form occurs most commonly in children between 2 months and 5 years

-diminished RBC production, usually triggered by infection with a virus

- a profound anemia results

-clinically similar to pneumonia

s/s = chest pain, fever, cough, tachpneaa, wheezing and hypoxia 

-Hydration 

-O2

-pain managment

-support (bedrest, joints straight, transfusions, remove restrictive clothing)

-Hydroxurea

-erythropoietin

-chelation therapy (for iron overload)