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Neuro Emergencies PDF
Neuro Emergencies PDF
Neurological
Emergencies
Sabreena Stratton
MSN, RN, CCRN, CEN
Learning Objectives
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1
9/14/14
http://chestofbooks.com/reference/American-Cyclopaedia-8/images/The-Brain-enclosed-in-its-Membranes-and-the-Skull.jpg
Neuro Anatomy
• Cranium
• Meninges: surround and
protect
• Dura (separates Cerebrum
from Cerebellum) aka:
Supratentorial
• Arachnoid
• Pia
• Brain
• 3 lbs
• 20% CO & 02 consumption
• Ventricles-interconnected
cavities
• Cerebrum
• Left and right
hemispheres
lobes
• Corpus
callosum
• Cerebellum
• Brainstem
https://headway.revolutiondata-cms.com/uploads/public/images/System%20Images/Sitepages/About%20brain%20injury/Brain%20lobes.jpg
Cranial Nerves
• Cranial Nerves
• Not consciously controlled I. Olfactory
II. Optic
• Cerebral Blood Flow III. Oculomotor
• Circle of Willis IV. Trochlear
V. Trigeminal
• Internal Carotid Arteries VI. Abducens
• Vertebral Arteries VII. Facial
• Venous drains through sinuses in VIII. Acoustic
dura into jugular veins IX. Glossopharyngeal
X. Vagus
• CSF XI. Spinal Accessory
• 7-10ml/hr XII. Hypoglossal
• Protector
• Transport system Unconscious?
III, IV, VI: pupils; eye
• Spinal Cord movement
• Spinal Canal from Brain Stem to V, VII: corneal, grimace
L-1 and L-2 IX, X: cough, gag
http://drroynissim.com/files/2012/08/Central-Nervous-System.jpg
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9/14/14
• 31 Spinal Nerves
• dermatomes
• Autonomic Nervous
System
• Sympathetic
• Fight or flight
• Parasympathetic
• Conserve energy
Peripheral Nervous
System
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Neuro Assessment
Level Of Consciousness
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9/14/14
Alert
u Oriented x4, awake, following
commands
Verbal
u Responds to voice; not fully
oriented
u Unresponsive
Unresponsive
AVPU
Level of Consciousness
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Herniation
Uncal: lateral shift of
brainàipsilateral dilated pupil
Pinpoint: parasympathetic
Dilated: sympathetic
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Monro-Kellie Doctrine
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EARLY LATE
Intracranial Pressure
EARLY LATE
Intracranial Pressure
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9/14/14
Heart rate
Increased: ↑ ICP
Cushing’s Reflex: Decreased: ↑ ICP (terminal), neurogenic
Hypertension, shock, autonomic dysreflexia
widening pulse Blood pressure
pressure, decreased Increased: ↑ ICP, autonomic dysreflexia
heart rate Decreased: ↑ ICP (terminal), neurogenic
shock
Respirations (abnormal): brain stem
Treatment?? compression
Temperature
Increased: hypothalamic injury,
neurogenic shock
Decreased: neurogenic shock
Vitals
SENSORY
Neuro Assessment
Treatment
CT head before Lumbar Puncture
Meningitis
6
9/14/14
Stroke
Treatment
ABC’s
Intubation
Manage SBP>220
HemorrhagicàSurgical
intervention and ICP manageent
http://floydmemorial.com/wp-content/uploads/2011/05/different_types_of_strokes.jpg
Stroke
Neuro Trauma
7
9/14/14
Extensive vascular
supply with poor
vasoconstrictive
properties
Direct pressure,
wound care, staples,
tDAP
Scalp Lacerations
Clinical presentation
affected by:
• type of fracture
• area involved
• damage to underlying
structures
S/S
• Combative
• Racoon Eyes
• Battle’s Sign
• Heotympanum
• CSF leak
Skull Fractures
Ø Bruising on the
surface of the brain
Ø Acceleration-
deceleration injuries
Ø S/S include:
Ø N/V, LOC, Vision Changes,
weakness, speech difficulty
Ø Management:
http://www.braininjury.com/images/injured01.gif
Ø Prservation of neuro
function
Ø Pain control
Ø Adequate hydration
Cerebral Contusions
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9/14/14
Epidural Hematoma
Subdural Hematoma
Bleeding into subdural space between the dura mater and arachnoid
http://img.medscape.com/pi/emed/ckb/radiology/336139-344482-6137tn.jpg
http://www.diagnosticimaging.com/sites/default/files/di/cases/Cocaine%20Induced%20Hypertensive%20Intraparenchymal%20Hemorrhage/03.jpg
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9/14/14
Concussion
http://cdn.lifeinthefastlane.com/wp-content/uploads/2010/04/Cubs_concussion.jpg
http://images.radiopaedia.org/images/2274466/45aad11d7ca2b2e23293dd6b50afe7.jpg
A patient who
sustained traumatic
brain injury in an
MVC 1 hour prior to
coming to ED by
ambulance.
He is combative, not
opening his eyes, and
groaning when his
open ankle fracture is
moved GCSà 8
10
9/14/14
Questions…
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9/14/14
A. Confusion
B. Slurred speech
C. Nuchal Rigidity
D. Lateral Nystagmus
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9/14/14
References
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