Adult III: Exam 4 Study Guide

What is the Monroe-Kelly Doctrine?

There are 3 rigid cranial vaults, or the rigid cranial vault contains 3 non-compressible contents—brain matter 80%, blood 10%, CSF 10%

• The Sum of the brain, the CSF (cerebrospinal fluid), and the intracranial blood volumes is consistent.

• An increase in one should cause a decrease in one or both of the remaining two —>Due to the limited space, an increase in one equals a decrease in the others, so this means that if CSF increases, the intracranial blood volumes and brain volumes should decrease

• Intracranial pressure is the sum of the pressures of the brain, cerebrospinal fluid, and intracranial blood.

What is normal adult ICP?

5-15 mmHG

How is cerebral perfusion pressure calculated?

What is normal cerebral perfusion pressure?

MAP - ICP = cerebral perfusion pressure

Ex: So, if MAP is 65 and ICP is 10, cerebral perfusion pressure is 55

Normal: 70 - 80 mmHg, so in the example above, that cerebral perfusion pressure is not sufficient

—>So when a patient is having neurological issues, a MAP of 65 is not good enough to perfuse the brain = if the patient has a neuro problem, they will likely have increased ICP, so MAP needs to be kept at higher to maintain a cerebral perfusion pressure of 70-80 mmHg

What is normal cerebral perfusion pressure?

What happens if cerebral perfusion pressure equals MAP?

70 - 80 mmHg

• If cerebral perfusion pressure = MAP, then cerebral circulation stops

What is cerebral perfusion pressure?

The pressure required to maintain adequate blood flow to the brain

You are given a question where you need to find out if a patient’s MAP is sufficient to maintain cerebral perfusion pressure, how do you do this?

Take the MAP and subtract ICP from it, then see if it is at least 70-80, if it is, MAP is sufficient

Verbalize the Glasgow coma scale

Verbal

• 4 = confused—i.e., know name, but not where they are at

• 3 = words—i.e., you ask them where they are and they say “brown cow”

• 2 = sounds—i.e., garbled, incomprehensible sounds

Motor

• 6 = obeys commands—i.e., squeezes your fingers or moves feet on command

• 5 = localizing—The patient purposefully moves toward the site of the painful stimulus (e.g., reaching up to grasp the examiner's hand and removing it from the supraorbital ridge)

• 4 = normal flexion (withdrawal)—the patient pulls away from the painful stimulus

• 3 = abnormal flexion (decorticate =)—the patient has rigid flexion of the arms, clenched fists, and adducted arms to the chest, with legs internally rotated and extended

• 2 = abnormal extension (decerebrate)—The patient exhibits rigid extension of the arms, adduction, and internal rotation of the shoulders, with pronation of the forearms and extended legs

• 1 = none (flaccid/no movement in response to painful stimuli)

What is decorticate posturing?

Decorticate posturing = an abnormal posture associated with severe brain injury, characterized by abnormal flexion of the upper extremities and extension of the lower extremities (flexion and internal rotation of forearms and hands)

Decorticate = flexion of upper extremities to the core—Think “core”; they are protecting their core

What is decerebrate posturing?

Decerebrate posture: Extension and external rotation of upper extremities with plantar flexion of the feet; an abnormal body posture associated with severe brain injury, characterized by extreme extension of the upper and lower extremities

• Decerebrate posturing indicates deeper and more severe dysfunction than does decorticate posturing; implies brain pathology; poor prognostic sign

A patient has a GCS of 3-8. What will likely be required to maintain life?

Intubation

• A GCS of 3-8 is severe

• A GCS of 3 in particular indicates severe impairment of neuro function, brain death, or pharmacologic intervention (i.e., w/ admin of pharmacologic paralyzing agents like neuromuscular-blocking agents)

List common conditions that affect GCS

1. Blood glucose

2. Electrolytes

3. Liver function

4. BUN/creatinine

5. Drugs/alcohol

6. Resp function alteration (Based on ABGs)

7. Calcium levels

When performing a neurological exam, what should you assess regarding language?

Assess fluency and spontaneity of speech, word finding ability and comprehendion; if intubated, cannot speak to you , so have them write on a white board or blink eyes

Expressive aphasia = broca’s aphasia—hard time word finding/completing verbal or written skills

Wernicke’s aphasia—response does not follow cntesxt on situation = receptive issue; ____

What is expressive aphasia?

Expressive aphasia = Broca’s aphasia—hard time word finding/completing verbal or written skills

What is Wernicke’s aphasia?

Wernicke’s aphasia—response does not follow context of the situation = receptive issue

List s/s of TBI of the following GCS ranges:

1. Mild (13-15)

2. Moderate (9-12)

3. Severe (3-8)

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?What is the major function of the ___ nerve? How do you assess its function?

What is the major function of the ___ nerve? How do you assess its function?