Acute Neuro NURS 324 Access to neurological expertise ANS 15 min Acetylchloline ANS Transmission of impulses is mediated by release of this neurotransmitter from the axon terminal Binds to endplate opens sodium channels and causes depolarization at endplate ACh Esterase ANS Breaks down acetylcholine Action Potential ANS Causes release of ACh in the synaptic cleft Acute Subdural Hematoma ANS CMS pupil irregularities focal motor and sensory deficit cranial nerve deficit Quick evacuation Admission to monitored bed ANS 3 hrs Afferent ANS Transmit info toward the center sensory nerve Anterior Cord Syndrome ANS Damage from infarction of anterior spinal artery Damage to anterior 2 3 of cord Corticospinal tract loss of motor function Anterolateral tract loss of pain temp coarse sensation Posterior 1 2 cord perserved postion vibration and fine touch unaffected Anterograde Amnesia ANS Memory loss post injury Anticoagulants Antiplatelets ANS Aspirin Ticlid Aggrenox Plavix Aphasia ANS disorder of comprehension or expression Arachnoid ANS Spider web appearance Contains CSF Arachnoid Villi ANS Absorb the CSF in venous circulation Astrocytes ANS Contribute to the blood brain barrier help with transport b w blood and neurons give metabolic support to neurons ATP in neurons ANS Maintain function of of sodium potassium ATPase Bacterial Meningitis ANS Strept pneumonia meningococcus H influenzae Symptoms headache fever stiffness of neck N V photophobia CMS cranial nerve problems seizures Severe high mortality high incidence of permanent severe neurological damage Blood Flow to Brain ANS Two internal carotid arteries anteriorly Vertebral arteries posteriorly Brain Blood Flow Rate ANS 15 CO 750 ml min Map 60 140 Brown Sequard Syndrome ANS Damage to half the cord Loss of voluntary motor function from the damage to corticospinal tract from ipsilateral side of body Loss of pain and temp sensation from damage to lateral spinothalamic tract from contralateral side of the body Cardiogenic Embolic Stroke ANS Traveling close most common in middle cerebral artery Cauda Equine ANS Collection of spinal canal below the termination of the spinal cord Central Cord Syndrome ANS Injury to central gray or white matter mainly in the cervical cord elderly Cortiocospinal tract that controls arms is located more centrally spastic paralysis of UE LE bowels bladder and sex function affected various degrees Chronic Subdural Hematoma ANS Low impact trauma Develops over weeks Progressive headaches CMS seizures visual disturbances motor and sensory problems CNS ANS Consists of brain and spinal cord concentration of computational and control functions Cognitive Deficits ANS Neglect memory loss visual impairment change in personality Coma ANS Unarousable and unresponsive to external stimuli Complete SCI ANS Absence of sensory and motor functions in the lowest sacral segments Compression Injury ANS Landing on head or butt fracture of vertebrae may be exacerbated by osteoporosis Concussion ANS Transient neuro dysfunction Brief loss of consciousness with amnesia Confusion ANS Impaired ability to think clearly or to perceive respond to or remember current stimuli disorientation Craniectomy ANS Removing a piece of skill to provide more room for swollen tissues Craniotomy ANS Draining CSF to control ICP Cytotoxic Edema ANS Involves an increase in intracellular fluid due to hypo osmotic states or ischemia Lack of ATP will impair the NA K ATPase sodium in cells followed by water Delirium ANS Motor restlessness transient hallucinations delusions agitation Depolarization ANS Spreads through entire muscles causing the calcium ions to be released in the cytoplasm Diencephalon Brain Injury ANS Impaired consciousness small reactive pupils decorticate posturing Chyene stokes respiration Diffuse Brain Injury ANS Trauma stroke etc cause cerebral function impairment with changes in LOC Door to CT Completion ANS 25 min Door to CT Interpretation ANS 45 min Door to doctor ANS 10 min Door to treatment ANS 60 min Dura Matter ANS Tough fibrotic layer main protective later of the brain Dysarthria ANS disorder of muscles that articulate speech Efferent ANS Transmit info toward the peripherally motor nerves Endplate ANS Specialized endplate of muscle membrane Epidural Hematoma ANS Between skill and dura arterial Accumulates fast and causes a lot of symptoms good outcome if evacuated quickly Unconcious regain lucidity rapid neuro deterioration with symptoms of brain compression Excitatory Amino Acid Causes ANS Stroke hypoglycemic injury trauma chronic degenerative disorders Huntingtons Alzheimers Glia ANS Protect NS supplies metabolic support participates in signaling between cells helps in their homeostasis Global Ischemia ANS Cardiac arrest Depletion of O2 in 10 sec depletion of glucose in 2 4 min and depletion of ATP in 5 min Global Ischemia Treatment ANS Restore blood flow and reverse hypoxemia decrease brain requirements hypothermia Golden Hour Treatment ANS Assessment of ABCs stroke patient evaluations and if eligible fibrinolytic therapy should be administered within 1 hr Gray Matter ANS cell bodies Hematomas ANS TBI blood collection Hemorrhagic ANS Caused by bleeding into brain tissue usually from a blood vessel rupture caused by HTN aneurysms arteriovenous malformations head injury or blood dycrasias Hemorrhagic Stroke Risk Factors ANS Advancing age hypertension aneurisms AV malformations trauma drugs anticoagulant Hemorrhagic Stroke Signs Symptoms ANS Vomiting headache on ones progressive symptoms Flaccidity spasticity coma Resultant edema increase pressure on brain herniation death Weakness of face arm or leg unilateral numbness and vision loss aphasia dysarthria ataxia Local sudden one sided High Lesions C1 or C2 ANS Vital capacity is 5 10 of normal and cough is absent High Thoracic Cord Injuries T2 T4 ANS Vital capacity is 30 50 of normal cough is weak Hospital Management of SCI ANS Airway management suction O2 intubation Ileus placement of NG tube essential and antiemetics Pressure sore prevention Steroid therapy Hyperextension Injury ANS Bending backward point of impact chin and face Hyperflexion Injury ANS Bending forward back of head point of impact Hypotension Treatment ANS NS LR supplemental oxygenation mechanical ventilation atropine for bradycardia foley catheter vasopressor prevent hypothermia Hypovolemic shock ANS Associated with tachycardia ICP Causes ANS Brain tumor vasodilation or obstruction of blood flow increases amount of