Term
|
Definition
| Ascending seonsory pathways in posterior cord and cerebral cortex |
|
|
Term
|
Definition
1) Somatosensory evoked potentials (SSEPs)
2) Brain Auditory Evoked Potentials (BAEPs) -for surgery near brainstem
3) Visual Evoked Potentials (VEPs)-for surgery at the base of the brain or near optic chiasm |
|
|
Term
| 4 factors that alter amplitude/latency of SEPs |
|
Definition
1) temp
2) decreased BP
3) PaCO2
4)PaO2 |
|
|
Term
| GA does what to amplitude and latency of SEPs? |
|
Definition
| It decreases amplitude and prolongs latency (directly proportional) |
|
|
Term
| Which SEP is most sensitive to GA? |
|
Definition
|
|
Term
| WHich SEP is intermediately sensitive to GA? |
|
Definition
| SSEP (Somewhat sensitive) |
|
|
Term
| WHich SEP is lease sensitive to GA? |
|
Definition
|
|
Term
|
Definition
| Measure descending motor pathways in the anterior spinal cord. |
|
|
Term
| Jugular Bulb venous oximetry |
|
Definition
| Gives balance between cerebral O2 supply and demand by calculating O2 sat in venous IJ blood |
|
|
Term
| Normal SjvO2 (Jugular bulb venous oximetry) |
|
Definition
|
|
Term
| What do you never do with a ventriculostomy |
|
Definition
|
|
Term
| Where do you balance a ventriculostomy drain to? |
|
Definition
| The foramen of munroe or auditory meatus |
|
|
Term
| ventriculostomy drainage bag is hung where? |
|
Definition
| 0-20cm below the auditory meatus, if it is hung too lung it can cause ventricular collapse |
|
|
Term
| Fiberoptic camino ICP monitor |
|
Definition
-Placed in the subdural space
-can check ICP, CBF, CO2, pH, and brain tissue O2 monitoring |
|
|
Term
| Incidence of VAEs with sitting cranies |
|
Definition
|
|
Term
| VAEs occur when the surgical site is _____ the level of the heart |
|
Definition
|
|
Term
| What is the most sensitive monitor for a VAE? |
|
Definition
|
|
Term
| What is the second most sensitive monitor for a VAE? |
|
Definition
| Doppler (detects air bubbles that are 0.25ml in size) |
|
|
Term
| Where do you place a doppler to check for VAE? |
|
Definition
| Right Sternum, 3-6 rib interspace |
|
|
Term
| What does a VAE sound like on a doppler? |
|
Definition
| "Mill Wheel" grinding sound |
|
|
Term
| Changes that occur with a VAE |
|
Definition
1) decreased CO
2) decreased gas exchange
3) V/Q mismatch
4) Foramen ovale pops open and can allow air to move into the arterial system |
|
|
Term
|
Definition
-flood field with saline, bone wax
-DC nitrous
-100% FiO2
-Aspirate air from CVP
-increase circ volume
-treat low BP
-head down position
-turn on left side (R atrium up)
-jugular compression |
|
|
Term
| If you have a multi-oriface CVP where should it be placed to aspirate for a VAE? |
|
Definition
| 2-3cm below the junction of R atrium and SVC |
|
|
Term
| If you have a single-oriface CVP where should it be placed to aspirate for a VAE? |
|
Definition
| 3CM above the junction of the R atrium and SVC |
|
|
Term
| Where should A-line be leveled to in sitting position? |
|
Definition
|
|
Term
| What IVF do you want to use in craniotomies? |
|
Definition
|
|
Term
| Blood sugar level for craniotomies |
|
Definition
|
|
Term
| Blood sugar reduces by how much with 1 unit of insulin? |
|
Definition
|
|
Term
| What are the 4 most stimulating phases of a craniotomy? |
|
Definition
1) laryngoscopy
2) tongs
3) incision
4) opening of the dura |
|
|
Term
| 2 most common causes of subarachnoid hemorrhage |
|
Definition
1) aneurysm
2) AV malformation |
|
|
Term
| Subarachnoid hemorrhage, ____ % have myocardial ischmia due to high catecholamines |
|
Definition
|
|
Term
| Insitute ICP monitoring in traumatic head injuries if GCS ___ after adequate resucitation of shock, ____ years of age, and SBP ____, and or posturing |
|
Definition
|
|
Term
| Initiate treatment in traumatic head injury when ICP is... |
|
Definition
|
|
Term
| Goal CPP in traumatic head injury |
|
Definition
|
|
Term
| Vasospasm post-bleed or post-clipping occurs how many days after surgery for an aneurysm |
|
Definition
|
|
Term
| CVP, PAP goal to prevent vasospasm |
|
Definition
|
|
Term
| Other goals to prevent vasospasm |
|
Definition
| HTN, Hemodilution (HCT 30%), Ca channel blockers |
|
|
Term
| During temporary aneurysm clipping, what is your goal MAP? |
|
Definition
| normal-high to maintain perfusion through the circle of willis |
|
|
Term
| During aneurysm repair without temp clipping what is your MAP target for deliberate hypotension? |
|
Definition
|
|
Term
| Ruptured aneurysm treatment |
|
Definition
1) hypotension
2) aggressive fluid and blood therapy
3) cerebral protective agents (pentothal)
4) carotid compression (up to 3 minutes) |
|
|
Term
| Supratentorial lesions are associated with what? |
|
Definition
|
|
Term
| Infratentorial lesions problems with mass effect on brainstem |
|
Definition
hemodynamic changes
arrhythmias
elevated ICP, reduces CPP |
|
|
Term
| Burst Suppression indications |
|
Definition
refractory status epilepticus
refractory intracranial hypertension
intraoperative neuroprotection |
|
|
Term
|
Definition
|
|
Term
|
Definition
| From T-5 to L-1, arises left, supplies the anterior artery |
|
|
Term
|
Definition
| methylprednisone 30 mg/kg over 1 hour then 5.4 mg/kg/hr over the next 23 hours |
|
|
Term
| Autonomic hyper-reflexia above injury |
|
Definition
flushing
sweating
nasal stuffiness/headache |
|
|
Term
| Autonomic hyper-reflexia below injury |
|
Definition
pallor
pilomotor erection
muscle contraction/spasm |
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|
