ABA Neurocritical Care flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Cerebral perfusion pressure formula

CPP equals mean arterial pressure minus intracranial pressure. Adult targets are typically 60–70 mmHg to maintain adequate cerebral blood flow without worsening intracranial hypertension.

Monro-Kellie doctrine

The skull is a rigid container holding brain, blood, and cerebrospinal fluid at fixed total volume. Expansion of one component must be offset by reduction in another or ICP rises.

Cushing reflex triad

Hypertension with widened pulse pressure, bradycardia, and irregular respirations. It signals raised intracranial pressure and impending brainstem compromise from herniation.

Uncal herniation pupil finding

A fixed, dilated pupil on the side of the lesion reflects CN III compression by the temporal lobe. It often precedes contralateral hemiparesis from corticospinal tract compression.

Hyperventilation for ICP

Brief reduction of PaCO2 to 30–35 mmHg causes cerebral vasoconstriction and rapid ICP fall. Prolonged use risks cerebral ischemia and is reserved for acute herniation.

Nimodipine in subarachnoid hemorrhage

Oral or enteral nimodipine 60 mg every 4 hours for 21 days reduces poor outcomes from delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

Status epilepticus treatment sequence

Give a benzodiazepine first, then a second-line IV antiseizure drug such as levetiracetam, fosphenytoin, or valproate. Refractory cases require continuous anesthetic infusion with EEG monitoring.

Glasgow Coma Scale range

GCS sums eye (1–4), verbal (1–5), and motor (1–6) scores for a range of 3–15. Scores of 8 or less usually prompt airway protection.

Brain death apnea test

After preoxygenation, disconnecting the ventilator should produce no respiratory effort despite PaCO2 rising to at least 60 mmHg or a documented 20 mmHg rise from baseline.

Targeted temperature management post-arrest

After cardiac arrest with coma, maintain a constant temperature between 32 and 36 degrees Celsius for at least 24 hours, then prevent fever, to limit hypoxic-ischemic brain injury.

Intraventricular hemorrhage EVD role

An external ventricular drain relieves obstructive hydrocephalus from intraventricular blood and allows ICP monitoring. It may be combined with intraventricular thrombolytic therapy in select cases.

Hypertonic saline for ICP

Concentrated sodium solutions (e.g., 3%, 7.5%, or 23.4%) draw water from brain tissue by osmotic gradient. Monitor sodium and osmolality to avoid overcorrection or renal injury.

Mannitol dosing for ICP

Mannitol 0.25–1 g/kg IV bolus creates an osmotic gradient to lower ICP. Hold if serum osmolality exceeds roughly 320 mOsm/kg or renal function is poor.

Seizure prophylaxis after ICH

Short-course prophylactic antiseizure medication is considered after lobar intracerebral hemorrhage or cortical involvement. Routine long-term prophylaxis is not recommended without clinical seizures.

Neurogenic stunned myocardium

Subarachnoid hemorrhage can cause reversible left ventricular dysfunction, troponin elevation, and pulmonary edema from catecholamine surge. Manage with supportive care and cautious fluid balance.

Sepsis-3 definition

Sepsis is life-threatening organ dysfunction from a dysregulated response to infection, defined by a SOFA score increase of 2 or more points from baseline.

Septic shock criteria

Septic shock requires vasopressor therapy to maintain MAP of 65 mmHg or higher plus lactate above 2 mmol/L despite adequate fluid resuscitation.

ARDS Berlin criteria

ARDS requires onset within one week, bilateral opacities not fully explained by cardiac failure, and PaO2/FiO2 of 300 or less on PEEP of at least 5 cmH2O.

Lung-protective ventilation targets

Use tidal volume of 6 mL/kg predicted body weight and keep plateau pressure at or below 30 cmH2O. This reduces ventilator-induced lung injury and mortality in ARDS.

First-line septic shock vasopressor

Norepinephrine is the initial vasopressor for septic shock. Add vasopressin or epinephrine to reach a mean arterial pressure target of 65 mmHg or higher.

KDIGO acute kidney injury staging

Stage by serum creatinine rise of 0.3 mg/dL within 48 hours or 1.5 times baseline within 7 days, and urine output below 0.5 mL/kg/h for 6 hours.

Stress ulcer prophylaxis indication

Mechanically ventilated patients and those with coagulopathy benefit from acid suppression with a proton pump inhibitor or H2 blocker to prevent gastrointestinal bleeding.

Ventilator-associated pneumonia criteria

New lung infiltrate plus fever, purulent secretions, or leukocytosis occurring after at least 48 hours of mechanical ventilation suggests ventilator-associated pneumonia.

DVT prophylaxis in ICU

Use low-molecular-weight heparin or unfractionated heparin for venous thromboembolism prevention unless contraindicated. Mechanical prophylaxis is used when bleeding risk is prohibitive.

Surviving Sepsis antibiotic timing

For septic shock, begin empiric broad-spectrum antibiotics immediately, ideally within one hour of recognition, after obtaining blood cultures when feasible.

Fluid resuscitation in sepsis

Give an initial 30 mL/kg crystalloid bolus for sepsis-induced hypoperfusion or septic shock within the first three hours, then reassess with dynamic measures.

Prone positioning in ARDS

Prone positioning for at least 16 hours per day improves survival in moderate to severe ARDS with PaO2/FiO2 below 150 mmHg when used with lung-protective ventilation.

Delirium screening in ICU

Use the Confusion Assessment Method for the ICU (CAM-ICU) or Intensive Care Delirium Screening Checklist. Positive screens prompt evaluation for reversible causes and nonpharmacologic management.

Glycemic control in critical illness

Initiate insulin for blood glucose above 180 mg/dL, targeting 140–180 mg/dL. Avoid intensive control below 110 mg/dL due to hypoglycemia risk.

Rapid sequence intubation preoxygenation

Provide high-flow oxygen or noninvasive ventilation before induction to build oxygen reserve. Give a sedative plus a neuromuscular blocker to minimize aspiration risk and apnea time.

Transfusion threshold in ICU

A restrictive hemoglobin threshold of 7 g/dL is appropriate for most critically ill adults. Consider 8 g/dL for active cardiac ischemia or acute bleeding.

Post-intubation sedation target

Use a validated scale such as RASS to titrate sedation, aiming for light sedation (RASS −2 to 0) unless deep sedation is required for specific conditions.