Comprehensive Neurological and Emergency Care: ICP, Trauma, and Disasters

What components make up Intracranial Pressure (ICP)?

Brain tissue, blood, and cerebrospinal fluid (CSF).

What is the normal range for Intracranial Pressure?

0-10 mmHg; 15 mmHg is the upper level of normal.

What happens when ICP exceeds 15 mmHg?

It raises concerns for decreased cerebral perfusion.

What is Cushing's Triad?

A sympathetic response characterized by decreased heart rate, increased blood pressure, and widening pulse pressure due to decreased cerebral blood flow.

What is the normal range for Cerebral Perfusion Pressure (CPP)?

70-100 mmHg.

What can decreased CPP lead to?

Ischemia, infarction, and neurological damage.

What are the earliest signs of increased ICP?

Decreased level of consciousness (LOC).

List some manifestations of increased ICP.

Severe headache, deteriorating LOC, restlessness, irritability, dilated/pinpoint pupils, slowness to react, altered breathing patterns, and abnormal posturing.

What is a major complication of increased ICP?

Brainstem herniation, which can lead to brain death.

What is Diabetes Insipidus?

A condition resulting from decreased secretion of Anti-Diuretic Hormone, leading to excessive urine output.

What is SIADH?

Syndrome of Inappropriate Antidiuretic Hormone secretion, causing fluid overload and decreased urine output.

What is a basilar skull fracture?

A fracture at the base of the skull that can leak CSF and is often caused by head trauma.

What are common manifestations of a basilar skull fracture?

Rhinorrhea, otorrhea, Battle sign, periorbital edema, and halo sign.

What defines a traumatic brain injury (TBI)?

An injury resulting from an external force that interferes with daily life and prompts medical treatment.

What are the two types of injuries in TBIs?

Primary injury (direct contact) and secondary injury (evolves over time).

What is a contusion?

Bruising and damage in a specific area of the brain, often resulting from severe trauma.

What characterizes a concussion?

No structural damage to the brain, with temporary loss of function, often from blunt trauma.

What is Chronic Traumatic Encephalopathy?

A condition seen in athletes with repeated head trauma, leading to personality changes and memory impairment.

What are the major types of intracranial hemorrhages?

Epidural, subdural, and intracerebral hemorrhages.

What causes an epidural hematoma?

Rupture of the middle meningeal artery, often associated with skull fractures.

What are the manifestations of an epidural hematoma?

Brief loss of consciousness followed by lucid intervals.

What is the significance of monitoring ICP?

To prevent complications such as brain herniation and ensure adequate cerebral perfusion.

What is the treatment for decreased CPP?

IV fluids and vasopressors to increase blood flow to vital organs.

What is the role of cerebral perfusion measures?

To assess how well the brain is being perfused.

What is the relationship between ICP and cerebral edema?

Increased ICP can lead to cerebral edema, which further exacerbates pressure and damage.

What is the recommended correction rate for serum sodium in SIADH?

No greater than 1.3 mEq/L/hr.

What are the signs of brain damage in increased ICP?

Abnormal posturing and deterioration in motor function.

What happens when compensatory mechanisms fail in TBI?

Increased intracranial pressure (ICP) occurs, leading to restlessness, agitation, confusion, coma, and possible herniation.

Why are epidural hematomas considered an emergency?

They rapidly form and can lead to neurological deficits or respiratory arrest within minutes.

What is the purpose of burr holes in TBI treatment?

Burr holes are drilled through the skull to help alleviate pressure.

What is a craniotomy?

A surgical procedure where a flap of the skull is removed to stop bleeding and then replaced.

What is a ventriculostomy?

A procedure that drains blood or cerebrospinal fluid (CSF) to relieve pressure.

What characterizes a subdural hematoma?

It is located below the dura mater and can push on brain tissue, commonly caused by trauma.

What are the symptoms of an acute subdural hematoma?

Change in level of consciousness (LOC), pupillary changes, and hemiparesis (one-sided weakness).

What distinguishes chronic subdural hematomas?

They develop from minor head injuries over weeks or months, often in older adults, and symptoms include headaches and fluctuating neurological signs.

What is an intracerebral hemorrhage?

Bleeding into the brain's parenchyma, often due to head injuries or systemic hypertension.

What are common treatments for intracerebral hemorrhage?

Supportive care, craniotomy, or craniectomy.

What is the difference between craniotomy and craniectomy?

A craniotomy temporarily removes a bone flap to stop bleeding, while a craniectomy permanently removes it to relieve pressure.

What is diffuse axonal injury (DAI)?

A type of brain injury characterized by widespread shearing and axon damage, leading to prolonged coma and poor outcomes.

What are the cardinal signs of brain death?

Coma, loss of brainstem reflexes, and apnea.

How can brain death be tested?

Through cerebral blood flow studies, EEG, and brainstem tests.

What is the Glasgow Coma Scale (GCS) used for?

To assess the level of consciousness in patients with brain injuries.

What vital signs indicate increased ICP?

Decreased heart rate, increased systolic blood pressure, and widening pulse pressure.

What medications are commonly used to manage ICP?

3% saline (hypertonic solution), mannitol (diuretic), and sedatives.

What position should a patient be in to help decrease ICP?

Head of bed elevated to 30 degrees.

What are the risks associated with excessive drainage from a ventriculostomy?

Ventricular collapse, meningitis, and ventriculitis.

What should be monitored in patients with severe brain injuries?

Intracranial pressure (ICP), neurological status, vital signs, and fluid/electrolyte balance.

What is the role of hyperventilation therapy in managing ICP?

It decreases PaCO2, leading to cerebral vasoconstriction and reduced cerebral blood flow.

What are the nutritional considerations for patients with metabolic changes?

Increased caloric needs and early feedings promote better outcomes.

What is TPN?

Total Parenteral Nutrition, provided through a central line.

What should be done if a patient requires an NG tube but has CSF leaking from their nose?

An OG tube (orogastric tube) should be used instead.

What are some precautions to take for patients in a coma or agitated state?

Assess weight, ensure the bladder is not distended, and use restraints cautiously to avoid increasing ICP.

How often should patients be turned to maintain skin integrity?

Every 2 hours.

What is the recommended frequency for skin care assessments?

Every 4 hours.

What is the importance of reducing stimuli in patient care?

It helps prevent agitation and potential complications.

What are the common causes of meningitis?

Bacterial (most common), viral, and fungal infections.

What are the two most common bacterial causes of meningitis?

Streptococcus pneumoniae and Neisseria meningitidis.

What are some risk factors for developing meningitis?

Living in close community settings, tobacco use, viral upper respiratory infections, and immunosuppression.

What are the classic clinical manifestations of meningitis?

Headache, fever, nuchal rigidity, positive Kernig's and Brudzinski's signs, photophobia, rash, change in LOC, and seizures.

What diagnostic tests are used for meningitis?

CT scan and lumbar puncture for CSF analysis.

What are the key findings in CSF analysis for bacterial meningitis?

High WBC count, high protein, and low glucose.

What is the first-line treatment for bacterial meningitis?

IV antibiotics within 24 hours of exposure.

What is a brain abscess?

A collection of infectious material within brain tissue.

What are the common manifestations of a brain abscess?

Headache, fever, vomiting, neurological deficits, seizures, and decreased LOC.

What is the treatment for a brain abscess?

Drainage of the abscess and large IV doses of antibiotics.

What is encephalitis?

Acute inflammation of the brain tissue.

What are the two types of encephalitis?

Herpes Simplex Virus (most common) and Arthropod-Borne Virus.

What are the nursing management priorities for patients with encephalitis?

Neurological assessment, monitoring response to treatment, and patient safety.

What does EMTALA stand for?

Emergency Medical Treatment and Active Labor Act.

What is the primary concern in emergency care?

Safety of patients, staff, and visitors.

What should be documented in emergency care?

Consent for treatment, patient interactions, and any incidents such as falls or fights.

What precautions should be taken regarding violence in the emergency department?

Implement security measures, separate conflicting family members, and monitor patients with psychiatric issues.

What is the role of the emergency nurse?

To assess patients' health problems in a crisis and provide urgent care.

What is the primary focus of emergency care?

Rapid assessment, treatment, and referral.

What does the acronym ABCDE stand for in emergency care?

Airway, Breathing, Circulation, Disability, Exposure.

What are the three categories patients can be triaged into?

Emergency, Urgent, Nonurgent.

What is the goal of the Emergency Severity Index (ESI)?

To facilitate rapid assessment and decision making.

What does ESI Level 1 indicate?

Requires a provider at the bedside immediately.

What is the most common cause of shock?

Hypovolemia.

What are the signs of internal bleeding?

Cool, clammy skin, low blood pressure, high heart rate, decreased urine output, increased capillary refill.

What is the main goal in managing hemorrhage?

To stop the bleeding.

What should be done if a patient has a partial airway obstruction?

Encourage the patient to deep breathe and cough if they have good airway exchange.

What is the significance of Grey Turner's sign?

It indicates ecchymosis on the flank, suggesting internal bleeding.

What is the first step in airway obstruction management?

Repositioning the patient's neck to open the airway.

What should not be used for airway management in patients with facial trauma?

Nasal airways.

What is the goal of wound care management?

To restore physical integrity and function of tissue while minimizing scarring and preventing infection.

What is the recommended method for documenting evidence in trauma cases?

Take photographs and document details accurately.

What is the triad of death in trauma patients?

Hypothermia, Acidosis, Coagulopathy.

What should be done for a patient with a suspected liver laceration?

Assess for referred pain to the right shoulder.

What is the purpose of a secondary survey in emergency care?

To complete health history and reassess after initial priorities have been addressed.

What is the significance of documenting before and after treatment?

It ensures accurate records of patient care and outcomes.

What is the recommended IV size for fluid replacement in hemorrhage management?

Large bore IVs: 18, 16, or 20 gauge.

What should be done if a tourniquet is applied?

It must be dated and timed with initials on it.

What is a common manifestation of airway obstruction?

Inability to speak, breathe, or cough, often accompanied by clutching the neck.

What is the importance of continuous assessment in the emergency department?

To monitor vital signs and reevaluate the patient's condition.

What is the first priority in managing multiple trauma patients?

Airway management.

What should be done for a patient with a gunshot wound to the abdomen?

Conduct an exploratory survey to identify internal injuries.

What is the role of social work in emergency care?

To assist with discharge planning and transitional services.

What imaging is the choice for intra-abdominal wounds?

Abdominal ultrasound is the imaging of choice for intra-abdominal wounds.

What should be monitored for in patients with abdominal injuries?

Monitor for signs and symptoms of shock, internal hemorrhage, and intraperitoneal injury.