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What are some terms for LOC?
- Confused – lacks ability to think clearly and rapidly
- Disoriented – lacks ability to recognize place or person
- Lethargic – awakens easily but exhibits limited responsiveness
- Obtunded – sleeps and, once aroused, has limited interaction with environment
- Stupor – requires stimulation to arouse
- Coma – vigorous stimulation produces no response
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What are most deaths related to ICP caused by?
Increased pressure to the brain stem!
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What is Cushing's Triad and what does it mean?
- Indicative of ^ ICP
- Consists of:
- --^ SBP
- --bradycardia
- --changes in RR and pattern
- (LOC may also be affected)
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What are some SnSs of ^ICP in infants?
- Irritability/restlessness, poorfeeding
- High-pitched cry, difficult to soothe
- Fontanels: tense, bulging
- Cranial sutures: separated/split = Increased OFC
- Eyes: “setting-sun” sign
- Scalp veins: distended
- Increased or decreased response to pain
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What are some SnSs of ^ICP in children?
- Headache
- Altered LOC
- Nausea and vomiting (especially in the morning, then fine for the rest of the day--> EMERGENCY!)
- Seizures
- Diplopia, blurred vision
- Mood swings
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What are some behavioral SnSs of ^ICP?
- Irritability, restlessness
- Complains to fatigue/somnolence/drowsiness-->decreased activity.
- Inability to follow commands, memory loss
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What are some late SnSs of ^ICP?
- • Severely Decreased LOC
- • Decreased motor response to command
- • Decreased sensory response to painful stimuli
- • Alterations in pupil size and reactivity
- • Papilledema (swelling of optic disc)
- • Decerebrate or decorticate posturing
- • Cheyne-Stokes respirations (infrequent, irratic breathing-->impending death)
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What are some examples of posturing associated with ^ICP?
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What is the GLASCOW scale?
- LOC metric
- 15 = best score
- 3 = worst (even dead pts will score 3)
- Consists of best:
- --verbal
- --motor
- --eyes
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What can you do for a pt with ^ICP?
- Don't do anything that will futher ^ICP, ie...
- --turn down lights
- --keep volumes down
- --HOB elevated
- --Tx pain
- --v cough
- --only suction to maintain airway
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What is Hydrocephalus and what can you do about it?
- Imbalance between the production and absorption of CSF.
- Tx with shunt to abd or heart.
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What are the 3 major causes of childhood head trauma?
- Falls
- MV crash
- Bike accidents
- (damage is typically caused by rapid acceloration/deceloration)
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What is trauma caused by initial impact?
coup
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Which is more dangerous: Subdural or epidural hematoma?
- Epidural: faster bleeding and faster ^ICP--> death quicker.
- Following injury, child will have brief period of lucidity then prodeed to rapidly lost LOC.
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What does SCIWORA?
- Spinal Cord Injury Without Radiologic Abnormality
- In infants, usually caused by shaking.
- In older kids, MV trauma, falls, dives, or violence.
- Tx with immobilization and steroids
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What is the most common neuro dysfunction on children?
Szr!
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What is the difference between primary and secondary szr?
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What are some possible etiologies of szr?
- febrile
- ^ICP for any reason
- Toxins
- Electrolyte imbalances
- Hyperbilirubinemia
- Birth injury/congenital defects
- Acute nfxn in late infancy/early childhood.
- 50% or idiopathic.
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What is a febrile szr?
- Usually at temps >38.8C (102F)
- Occures as temp rises, not after
- Almost always has no lasting neuro consequences
- Rare after 5 yrs.
- Tx by:
- No tepid bath!
- Antipyretics
- Call 911 if longer than 5 min
- Protect child from trauma during szr.
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What is Status Epilepticus?
- Szr lasting more than 30 minutes continuous or in episodes without regaining normal LOC.
- Tx:
- Maintain airway
- Get IV access
- Rx with Diastat, IV Diazepam/Lorzepam, or Versed.
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What are some other common anticonvusants?
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