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Chapter 29. Neurosurgery

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A patient is intubated in the ICU, but can follow commands with his right arm, extends with his lower extremities, and does not move his left arm. His eyes open to command. What is his GCS?

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A. 14T

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B. 11T

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C. 10T

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D. 9T

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E. 5T

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This patient would get 1 point out of 5 for verbal (the lowest that you can get in a single category is 1), but would get the designation T to indicate that he is intubated. He would get all 6 points for verbal because this follows the best result (the right arm). He would get 3 out of 4 points for eyes.

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A patient comes into the trauma bay with a large laceration of his scalp with a skull deformity after a motor vehicle collision. He seems to be moving all 4 extremities spontaneously, and he is tachycardic. He has a large pool of blood on the stretcher. He also has a large flail segment of his right chest. What should your first move be?

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A. Attempt to stop the bleeding with pressure or with suture repair of his scalp

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B. Transfer the patient to CT scan to rule out intracranial trauma

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C. Assess the patient’s airway

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D. Transfuse 2 units of uncross-matched blood

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E. Obtain a chest x-ray

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When in a trauma resuscitation, the first priority is to secure the patient’s airway. All other choices may be necessary, but the airway is of prime importance.

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You are seeing a patient in the ICU who has suffered a head injury. He has a ventricular monitor placed for measuring intracranial pressure, as well as an arterial catheter placed. His blood pressure is 120/80 with a mean of 90 and his ICP is 20. What is his cerebral perfusion pressure?

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A. 100

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B. 90

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C. 80

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D. 70

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E. 60

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Cerebral perfusion pressure is defined as MAP – ICP. In this case, 90 – 20 = 70.

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Which intracranial component can be affected most rapidly to decrease intracranial pressure in an acute situation?

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A. Intravascular blood

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B. Cerebral spinal fluid

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