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What carries well localized, sharp pain and is important in initiating rapid reactions to stimuli causing fast pain?
medium-sized A-delta fibers
(GATE CONTROL THERAPY)
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What can stimulation of large, fast, heavy myelinated Alpha-beta fibers do?
close pain gates
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What contributes to pain modulation (inhibition) in medulla gates and pons?
norepinephrine and serotonin
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Where do large, fast, heavy myelinated Alpha-beta fibers synapse?
dorsal horn of spinal cord along with their nociceptive Alpha-delta and C fiber counterparts
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Describe referred pain.
area removed or distant from point of origin
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Describe somatic pain.
skin or close to surface, sharp and localized
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Describe acute pain.
somatic, visceral, or referred
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What are the 4 types of endogenous opioids?
- 1. enkephalins
- 2. endorphins
- 3. dynorphins
- 4. endomorphins
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Where does endogenous opioids inhibit transmission of pain impulses?
spinal cord and brain
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Morphine-like neuropeptides act as neurotransmitters by binding to one or more opioid receptors, what do you call this?
endogenous opioids
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Why might pain be increased if someone has inadequate sleep?
because serotonin is produced during sleep, and serotonin decreases pain
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What does "gate" in the spinal chord do?
regulates transmission of pain impulses that proceed cephalad for further processing and interpretation in the brain
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What will a patient's LOC be in decerebrate posturing?
stupor to coma
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What does someone look like in decerebrate posturing?
arms are rigid turned away from the body
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What area of the brain is involved in decerebrate posturing?
midbrain and/or pons
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What will some look like in decorticate posturing?
flexed upper extremities, extended lower extremities
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What area of the brain is involved in decorticate posturing?
diencephalon
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What are the sign associated with stage 2 nonresponsiveness (midbrain)?
stupor or coma, neurogenic hyperventilation, midposition fixed pupils (MFP)
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What are the signs associated with the eyes related to stage 1 nonresponsiveness (diencephalon)?
pupils respond briskly, full-range eye movements only on "doll's eyes" (eyes won't move while move head, fixed position) or after injection of hot or cold water in eat canal (caloric posturing)
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What are some manifestations of the first stage of non responsiveness (diencephalon)?
agitated, dull, lethargic, obtundation
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What the progression of nonresponsiveness?
- 1. diencehpalon (thalamus/hypothalamus)
- 2. midbrain
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What is stuporous?
can wake back up but go back to sleep, brain still functioning but lose consciousness
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What are some signs of hypothermia?
shivering, thinking becomes sluggish, decreased coordination, stuporous, decreased HR and RR, decreased cardiac output, and moderate to severe acidosis
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What is hypothermia secondary to?
hypothyroidism, hypopituitarism, malnutrition, Parkinson's disease, rheumatoid arthritis
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When does some have hypothermia, at what degree?
94 degrees F or lower, so 95 degrees F is NOT hypothermia yet.
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Slows chemical reactions, increases blood viscosity, slows blood flow, facilities blood coagulation, stimulates profound vasoconstriction, what is this?
hypothermia
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What are some signs of a heatstroke?
sweating ceases (core temp rises rapidly), skin dry and flushed (vascular collapse), irritability, confusion, stuporous, comatose (cerebral edema, degeneration of CNS, and renal tubular necrosis)
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What will the regulatory center do is a fever goes above 105 degrees F?
cease to function
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What happens if a fever goes higher than 105 degrees F?
damages the neurons
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Up to what degree can the brain tolerate?
105 degrees F
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Why does a heatstroke happen?
the thermoregulatory center is overstressed
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What age group is most at risk for a heatstroke?
babies and the elderly
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What is a potentially lethal consequence of a fever?
heatstroke
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Interleukin-1 (IL-1), IL-6, interferons and TNF produced and released as exogenous bacteria are destroyed and absorbed by phagocytic cells in host, when does this process occur?
during fever
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What does the hypothalamus do during a fever?
raises the set point
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What does fever begin with?
introduction of exogenous pyrogens or endotoxins
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What is failure of normal thermoregulatory mechanism?
fever
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In thermoregulation, what does release of epinephrine and adrenal medulla cause?
vasoconstriction, glycolysis, and increased metabolic rates
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In thermoregulation, what does thyroxine cause release of?
epinephrine from adrenal medulla
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In thermoregulation, what does TSH cause release of?
thyroxine from thyroid
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What results in release of TSH from anterior pituitary?
heat production/thermoregulation
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Besides infection, what is something else fever can result from?
head trauma
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What is released with heat production?
TSH-RH
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Where does heat production begin?
in hypothalamus
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Cutaneous and visceral neurons converge on same ascending neuron and brain cannot distinguish between origin of the two, what type of pain is this?
referred
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Area supplied by same spinal segment as actual site of injury (upper abdomen - T8, L1, L2), what type of pain is this?
referred
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Describe visceral pain.
internal organs, abdomen, skeleton
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What can cause obtundation?
anesthesia or intracranial pressure
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What is coma?
no arousal to any stimulus but brainstem reflexes intact
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What is stupor?
arouses only to painful stimuli
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What is obtundation?
awakens in response to stimulation, continuous stimulation needed for arousal, eyes usually closed
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What is lethargy?
orientation X3 but slow vocalization, decreased motor skills
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What is confusion?
alteration of perception of stimuli (time, then place, then person)
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What is consciousness?
alertness with orientation to person, place and time
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No correctable cause for seizures is found and seizures are recurrent without treatment, what is this?
epilepsy
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Follows a generalized tonic-clonic seizure and they are sleepy, what is this?
postictal sate
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What is the occurrence of second, third or multiple seizures before the person has fully regained consciousness from preceding seizure and causes cerebral hypoxia?
status epilepticus
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What are two age groups who have unclassified epileptic seizures?
neonatal seizures and infantile seizures
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What happens in an atonic seizure?
pass out
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What happens in a tonic-clonic seizure?
aura precedes and they're stiff and jerk
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What happens in a tonic seizure?
muscle contraction with excessive muscle tone
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What happens with a clonic seizure?
alternating contraction and relaxation of muscles
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What are 5 different types of generalized seizures?
absence, clonic, tonic, tonic-clonic, and atonic
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Bilaterally symmetric and without local onset, consciousness is always impaired or lost, what type of seizure is this?
generalized seizure
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Partial onset evolving into generalized tonic-clonic seizures, what is this called?
secondarily generalized
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With impairment of consciousness, with to without automatisms, what type of seizure is this?
partial - complex
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without impairment of consciousness, with motor signs, special sensory or somatosensory symptoms [prodroma] hours to days before seizure, autonomic symptoms and psychic symptoms, what type of seizure is this?
partial - simple seizure
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begin locally, involve neurons unilaterally, what type of seizure is this?
partial seizure
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What are seizures characterized by?
sudden transient alterations in brain function
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Caused by abnormal excessive hypersynchronous discharges of CNS neurons, what is this?
seizures
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What is death of cerebral hemispheres exclusive of brainstem and cerebellum?
cerebral death
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What may the brain continue to do in cerebral death?
maintain cardiovascular and respiratory functions. Normal T control, and normal GI functions
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When someone is permanently unable to respond in any way to environment, what has happened to them?
they have cerebral death
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What is irreversible coma?
cerebral death
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What do you have destruction of in brain death?
destruction of the brainstem and cerebellum
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When irreversible brain damage allows no potential recovery and can no longer maintain respiratory and cardiovascular functions, what is this?
Brain death (brainstem death)
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Why does someone with cerebral death still have a heart beat and is still breathing?
because is doesn't involve the brainstem and cerebellum
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What is responsible for transmission of diffuse burning or aching sensations causing slow pain?
small unmyleinated C polymodal nociceptors
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