Term
| what is first line treatment for brain injury pts? (includes 2 things) |
|
Definition
|
|
Term
| goal for sedation and analgesia? |
|
Definition
| minimize ICP effects without disturbing ability to assess neuro status |
|
|
Term
what is the main sedative?
what is second line?
is there a diff in effectiveness? |
|
Definition
|
|
Term
| what are the main analgesic agents?-2 |
|
Definition
|
|
Term
| what do you want to avoid with brain injury pts and analgesic treatment? |
|
Definition
| high bolus doses (large shifts in flucuation) |
|
|
Term
why dont you use dexmatdomindine in brain injury pts? -2
which of these is seen in propofol and morphine and needs to be monitroed? |
|
Definition
drops BP and bradycardia
drop in BP |
|
|
Term
| why isnt meperidine used in brain injury pts? |
|
Definition
|
|
Term
what is the mechanism hyperosmsolar therapy ?
what 3 things does this do? |
|
Definition
makes an osmotic gradieint to pull water from brain into vasculature
-increased blood volume
-reduces viscosity
-imrpoves cereberal flow |
|
|
Term
| what are the 2 hyperosmolar agents? |
|
Definition
mannitol
hypertonic saline |
|
|
Term
| you use mannitol as continuous or intermittent? why? |
|
Definition
intermittent ;4-6 hrs at a time
if cont. some will cross BB and cause osmotic action ther to pull more fluid into brain (not good!) |
|
|
Term
| what is the IV bolus dose of mannitol? |
|
Definition
|
|
Term
|
Definition
kidney injury
electrolyte abnormalites
diuresis |
|
|
Term
| what do you need to montitor for mannitol?-2 |
|
Definition
serum osmolality < 320
serum Na <160 (or disct) |
|
|
Term
| which hyperosmolar agent needs to be filtered? |
|
Definition
|
|
Term
| hypertonic saline dosing? |
|
Definition
| not know; 3-23.4% volumes |
|
|
Term
| why might you use hypetonic saline of mannitol? |
|
Definition
| doenst cause diuersis so it helps with volumeresuscitation |
|
|
Term
| monitoring for hypetonic saline? -2 |
|
Definition
Na < 155 ordisct
dont do more than 12 mEq/L in 24 hrs |
|
|
Term
| what 2 second line therapies should not be used any longer?! |
|
Definition
preventative hyperventilation
steroids (CRASH trial) |
|
|
Term
| what are some second line therapies?-2 |
|
Definition
barbituate coma
hypothermia |
|
|
Term
| the non drug strategy that is only temprary benefit |
|
Definition
|
|
Term
| non drug therapy with mixed results |
|
Definition
| decompressive craniectomy (reomve portion of skull) |
|
|
Term
| what non drug therapy can be used for rrfractory ICP |
|
Definition
|
|
Term
| when do you put a pt in a barbituate coma?-2 |
|
Definition
refractory to osmotics
contraindicated for osmotics |
|
|
Term
| proposed mechanism for barb coma? |
|
Definition
| reduced cerebral metabolic demand and blood flow |
|
|
Term
| ADEs of barbitaute coma-3 |
|
Definition
hypoK
maks infeciton
cardiovasc depression :hypotension, lactate |
|
|
Term
what is the main barbituatE?
what is second line? |
|
Definition
|
|
Term
| why is thiopental not first line barb? |
|
Definition
| bc less studies to prove evidence |
|
|
Term
| what are the clinical points to remember about pentobarbital |
|
Definition
may cause hypotension
very long t 1/2
loading dose then cont infusion |
|
|
Term
| monitor babrituate coma how? |
|
Definition
|
|
Term
a pt should be in barb coma until when?
then what do you do? |
|
Definition
ICP control maintained
titrate over 24-72 hours |
|
|
Term
| only do treatmen for HTN in TBI if above? |
|
Definition
| 180 (dont want JNC goal!) |
|
|
Term
| hypotension treatment? -2 |
|
Definition
fluid resusciation
vasopressor |
|
|
Term
|
Definition
|
|
Term
| HTN in these pts can be in response to?-4 |
|
Definition
increased ICP
pain
anxiety
chronic HTN |
|
|
Term
|
Definition
|
|
Term
the worry about lowering BP in these pts?
the worry with HTN in the pts |
|
Definition
may exacerbate ischemia
may worsen bleed |
|
|
Term
*** SBP>200 or MAP >150:
_ treatment of BP with _ infusion and BP monitoring _ |
|
Definition
aggressive
continuous
every 5 minutes |
|
|
Term
*** SBP>180 or MAP >130 and possible increase ICP:
use _ infusion for BP (2)
monitor _ with goal of CPP _ |
|
Definition
continuous or intermitten
ICP
> or equal to 60 |
|
|
Term
** SBP>180 or MAP>130 and ICP not elevated:
_ reduction of BP with target BP _
using _ infusion and montioring _ |
|
Definition
modest
160/90
intermittent
every 15 minutes |
|
|
Term
| *** know with more data we may be shotting for lower BP goal |
|
Definition
|
|
Term
| what you want in a BP lowerinbg agent-2 |
|
Definition
short acting
no abrupt drop in BP |
|
|
Term
what BP medds are for cont infusion-2
why are they so good?-2 |
|
Definition
nicardipene; clevidipine
since dihydroper no ionotrope or chronotrope |
|
|
Term
| what is a BP drug for intermittent infusion |
|
Definition
|
|
Term
| what agents do you dsict if high BP? -2 |
|
Definition
| nitro products that dilate (increase ICP) |
|
|
Term
which has higher seizure risk, TBI or ICH?
whihc is mostly in first 24 hrs? |
|
Definition
|
|
Term
| risk factros for TBI and seizure?-4 |
|
Definition
GCS<10
seizure in first 24 hrs
hematoma
skull fracture |
|
|
Term
| when do you reccomend and for how long seizure prohylaxis for TBI? |
|
Definition
| if have 1 risk factor. use for days bc after that doesnt prevent them |
|
|
Term
| when do you reccomend seizure prophylaxis for ICH? how long od you treaT? |
|
Definition
|
|
Term
what are the two agents for seizure prophylaxis?
which may be better and why? |
|
Definition
levetiracetam and phenytoin
levetir- less ADEs |
|
|
Term
what is reccomended for VTE prophylaxis?
when do you switch? |
|
Definition
intermittent compresison devices
switch to chemical when bleeding risk declined |
|
|
Term
| what is first indicator for sdoium disordeR? |
|
Definition
|
|
Term
if pt has hypernatremia what is probably the etiology?
what is the treatment? |
|
Definition
diabetes
volume resus.; desmopressin |
|
|
Term
if pt has hyponatremia from SIADH what is the cause and treatment?
what if from cerebral salt wasting syndrome? |
|
Definition
water reasborpt; vaptan
excessive natriuetic peptide; saline volume resusct; fludrocortisone |
|
|
Term
what are other treamtent reccomendation for ICH?
for TBI?
for both? |
|
Definition
reversal of anticoagulaiton
reversal of hyperthermia (even tho no data for outcomes)
stress ulcer prophylaxis |
|
|
Term
for nutrition, ahcieve goal in _ days
what what kind of diet high in -2
also want _ control |
|
Definition
7
high cal and protein
glycemic |
|
|
