ABEM Neurocritical Care flashcards

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

Alteplase dose for stroke

For eligible acute ischemic stroke within 4.5 hours, give 0.9 mg/kg intravenously, maximum 90 mg, with 10% as a bolus and the rest over 60 minutes.

Thrombolysis blood pressure limits

Before intravenous thrombolysis, lower blood pressure to less than 185/110 mmHg; for 24 hours afterward, maintain blood pressure below 180/105 mmHg.

Thrombectomy time window

Mechanical thrombectomy is standard for anterior circulation large-vessel occlusion within 6 hours of last known well; selected patients with salvageable tissue may be treated up to 24 hours.

ICH systolic target

In mild-to-moderate spontaneous intracerebral hemorrhage, start antihypertensive treatment when systolic pressure exceeds 150 mmHg and target 130 to 150 mmHg, avoiding systolic below 130 mmHg.

Nimodipine after SAH

For aneurysmal subarachnoid hemorrhage, give nimodipine 60 mg orally every 4 hours for 21 days to reduce delayed cerebral ischemia and poor outcome.

Aspirin after ischemic stroke

Start aspirin 160 to 325 mg within 24 to 48 hours after ischemic stroke; if thrombolysis was given, delay antiplatelet therapy until 24 hours after treatment.

Malignant MCA infarction

Decompressive hemicraniectomy within 48 hours reduces mortality in selected patients aged 60 years or younger with malignant middle cerebral artery infarction and early neurologic deterioration.

CPP formula

Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure; in traumatic brain injury, the usual target range is 60 to 70 mmHg.

ICP treatment threshold

In traumatic brain injury, intracranial pressure above 22 mmHg is generally treated because sustained elevation is associated with worse outcomes.

Hypertonic saline bolus

A 250 mL bolus of 3% hypertonic saline can lower intracranial pressure; monitor serum sodium and osmolality to avoid overly rapid correction.

TBI hypotension thresholds

After traumatic brain injury, keep systolic blood pressure at least 100 mmHg for ages 50 to 69 and at least 110 mmHg for ages 15 to 49 or over 70.

TBI seizure prophylaxis

After severe traumatic brain injury, give seizure prophylaxis for seven days; prophylactic antiseizure drugs do not prevent late posttraumatic epilepsy.

Steroids in TBI

Glucocorticoids are not recommended for traumatic brain injury because high-dose steroids increase mortality; high-dose methylprednisolone is also not recommended for acute spinal cord injury.

Spinal cord MAP target

In acute spinal cord injury, a mean arterial pressure target of 85 to 90 mmHg for five to seven days may be used in selected patients after careful risk assessment.

Status epilepticus definition

Status epilepticus is continuous seizure activity lasting at least five minutes or two or more seizures without full recovery of consciousness between them.

First-line status epilepticus

Give intravenous lorazepam 0.1 mg/kg, maximum 4 mg, or diazepam as first-line therapy; if there is no intravenous access, use intramuscular midazolam 10 mg.

Second-line status epilepticus

After benzodiazepines, choose fosphenytoin 20 phenytoin equivalents/kg, valproate 40 mg/kg, or levetiracetam 60 mg/kg to stop status epilepticus.

Refractory status epilepticus

Refractory status epilepticus requires continuous intravenous midazolam, propofol, or pentobarbital with electroencephalographic monitoring, titrated to seizure suppression or burst suppression.

Myasthenic crisis treatment

Myasthenic crisis is treated with intravenous immunoglobulin or plasma exchange; monitor vital capacity and negative inspiratory force, and avoid aminoglycosides and magnesium when possible.

Guillain-Barré syndrome therapy

Guillain-Barré syndrome is treated with intravenous immunoglobulin or plasma exchange; glucocorticoids alone do not improve recovery and are not recommended as monotherapy.

ICP monitor indication

Place an intracranial pressure monitor in severe traumatic brain injury with an abnormal computed tomography scan, or with a normal scan plus age over 40, motor posturing, or systolic pressure below 90 mmHg.

Lundberg plateau waves

Lundberg A waves are plateau waves of intracranial pressure lasting five to twenty minutes; they reflect impaired intracranial compliance and can precede herniation.

Brain tissue oxygen threshold

Brain tissue oxygen tension normally ranges about 25 to 35 mmHg; values below 15 to 20 mmHg indicate increased risk of ischemic injury after severe brain injury.

TCD vasospasm criteria

Transcranial Doppler suggests middle cerebral artery vasospasm when mean flow velocity exceeds 120 cm/s and the Lindegaard ratio is greater than 3.

EVD zero reference

An external ventricular drain is zeroed at the tragus or midbrain level; keep the drainage height at the ordered level and avoid rapid excessive cerebrospinal fluid removal.

Warfarin ICH reversal

For warfarin-associated intracerebral hemorrhage, give intravenous vitamin K plus prothrombin complex concentrate; for dabigatran-associated hemorrhage, idarucizumab is the specific reversal agent.

Lung-protective ventilation

Use tidal volume 6 mL/kg predicted body weight, keep plateau pressure at or below 30 cmH2O, and target PaCO2 35 to 45 mmHg unless hyperventilation is specifically indicated.

Neurocritical glucose target

In neurocritical care, target blood glucose 140 to 180 mg/dL; avoid intensive control below 110 mg/dL because hypoglycemia can worsen brain injury.

Fever after brain injury

Fever after brain injury increases cerebral metabolic demand; treat temperatures above 38°C with antipyretics and surface cooling while investigating infection and other causes.

Hyponatremia correction limit

Correct chronic hyponatremia by no more than 8 to 10 mmol/L in 24 hours to reduce the risk of osmotic demyelination syndrome.

Post-arrest prognostication

After cardiac arrest, prognostication should be multimodal and delayed at least 72 hours; use pupillary and corneal reflexes, SSEP N20, EEG, neuron-specific enolase, and imaging.

Brain death apnea testing

Brain death requires irreversible coma, absent brainstem reflexes, and apnea in the absence of confounders; ancillary testing is used when apnea testing cannot be completed safely.