AHN 572 NEURO 1, ACTUAL QUESTIONS AND

AHN 572 NEURO 1, ACTUAL / QUESTIONS AND

VERIFIED CORRECT ANSWERS

Types of acceleration/deceleration SCI (4) - ----Answers---1.Hyperextension

• Hyperflexion
• Compression
• Whiplash

Hyperextension SCI - ----Answers---Usually a fall on face, forehead, or chin

• Rear end collision resulting in rupture of antherior

longitudinal ligament

• may cause cord to stretch, resulting in central cord

syndrome

Hyperflexion SCI - ----Answers---Greatest stress occurs C5- C6, causing bilateral facet dislocation Management of cardiogenic shock - ----Answers----Stabilize initially -Supplemental oxygen -Crystalloid if no pulmonary edema -PA catheter, arterial line, Foley -Dobutamine max 40 mcg/kg/min -Dopamine 5-10 mcg/kg/min 1 / 4

Management of obstructive shock - ----Answers----Treat underline cause, ABCs, fluids, vasopressors, possible emergency surgical intervention

Management of anaphylactic shock - ----Answers----AIRWAY -Remove antigen

-Epi SubQ (.5-1 mL of 1:1000)

-Antihistamine, Benadryl, Pepcid -Fluids, pressors as needed

Management of neurogenic shock - ----Answers----Secure airway and spine -Fluids, pressors, treat bradycardia, treat hypothermia

Management of septic shock - ----Answers----Airway -Fluids, pressors -Broad-spectrum antibiotics, follow labs -Treat hyper/hypo thermia, nutrition

Shock Stage I - ----Answers---No real signs early, high index of suspicion, need to follow trends

Shock Stage II - ----Answers----Compensatory -Fight or flight hormonal, volume and energy 2 / 4

-Chemical V/Q changes -Blood pressure normal, but MAP decreased -Tachycardic -Decreased LOC or euphoric -Tachypnic, clammy -Hyperglycemia, hyponatremia, Respiratory alkalosis

Shock Stage III - ----Answers----Compensation is failing -Capillary hydrostatic pressure increases, body begins to prioritize blood flow -Decreased urinary output, decreased LOC, Hypotensive, tachycardic, cool and clammy, hypoventilation -Lactic acidosis

Shock Stage IV - ----Answers----Refractory, irreversible and organ damage -ARDS, DIC, ATN, and farts of heart and brain, dead gut

Universal treatment of shock - ----Answers----Maintain airway and ventilation -Hemodynamic monitoring -Keep MAP>65, Mixed Venous O2 Sat > 65%, euvolemia -Fluid therapy, urinary output goal 0.5 ML/KG/hour -Correct acid base in balance, bicarb may be given to increase pH above 7.2 -Mild permissive hypercapnia may be indicated to maintain plateau pressure < 30 cm 3 / 4

Hypovolemic/Hemorrhagic shock Treatment - ----Answers---

• Vasopressors
• Fluid Challenge, 250-500 bolus LR/NS, repeat for low

BP/CVP

• Fluid Replacement
• Blood
• Crystalloids
• Colliods (albumin)

cardiogenic shock treatment - ----Answers---1. improve CO and contractility

• Supplemental oxygen
• Fluid resuscitation unless pulmonary edema is present
• A-Line
• Foley
• Dobutamine max 40 mcg/kg/hr
• Dopamine 5-10 mcg/kg/min
• Nitroglycerin if related to ischemia

Anaphylactic shock treatment - ----Answers---1. Epinephrine should be given to all patients with respiratory difficulty or hypotension

• Maintain airway, intubate if needed
• Antihistamine - benadryl
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