Perfusion Part 2

Anemia can occur 3 different ways which each have different
catagories of how they occur. What are the 3 ways?

1. Blood Loss or Destruction
2. Nutritional
3. Bone Marrow Suppression/failure

What is the difference between acute and chronic blood loss?


Name the hemolytic anemias.

Hereditary cell membrane disorders
Defective hemoglobin (Sickle and Thalassemia)
G6PD deficiency

What are the autoimmune hemolytic anemias

Warm antibody
Cold anitbody

What kind of anemia is due to altered Hemoglobin synthesis?

Iron Deficiency

What kinds of anemia are due to altered DNA synthesis?

Folic acid

What kind of anemia is due to bone marrow suppression/ failure?

aplastic or stem cell dysfunction

What are the platelets or clotting factor disorders?

Hemophilia A & B
Von Willebrands

What are the DVT assessment findings?

pain, swelling and tenderness in one of your legs (usually your
calf) a heavy ache in the affected area. warm skin
in the area of the clot. red skin, particularly at the back
of your leg below the knee. Homan's sign- (calf pain at
dorsiflexion of the foot)

What are the DVT causes?

Illness or injury that causes prolonged immobility
Age > 40
Pregnancy, birth control pills and hormone replacement therapy
Cancer and its treatment
Major surgery (ex: abdomen, pelvis, hip facture, knee fracture, hip
or knee replacement)
Surgery time > 30 minutes
Indwelling vascular devices
Previous DVT or PE

How do you diagnose a DVT?


What are DVT risk factors?

Major risk factors for DVT include: heart failure, severe respiratory
disease and sepsis.

How does prophylaxis and treatment for a DVT differ?


What causes a pulmonary embolus?

Vascular disease
Foreign bodies (IV/central venous catheters)
Certain disease states (combination of stasis, coagulation
alterations, and venous injury)
Heart disease (especially heart failure)
Trauma (especially fracture of hip, pelvis, vertebra, lower extremites
Venous Stasis (slowing of blood flow in veins)
Prolonged immobilization (especially postop)
Prolonged periods of sitting/traveling
Varicose veins
Spinal cord injury
Hypercoagulability (due to release of tissue thromboplastin after injury/surgery)
Tumor (pancreatic, GI, breast, lung)
Incidence higher in Black patients

What is used to diagnose a pulmonary embolus?

Metabolic panel
Chest x-ray
V/Q scan
Pulmonary angiography (Gold Standard)
CT-PE or helical (spiral) CT

What are the two different kinds of stroke?

Ischemic and Hemorrhagic

What are the two different kinds of Ischemic stroke and how are they
different from one another?

Embolitic stroke - clot breaks off from somewhere else in the body
and travels to the brain
Thrombolytic stroke - Clot develops in the brain

What does B.E.F.A.S.T. stand for?

B - balance
E - eyes
F - face
A - arm
S - speech
T - time

What can cause a hemorrhagic stroke?

Physical inactivity
Heavy/Binge drinking
Use of illicit drugs
(cocaine/Methamphetamines)?Medical?Uncontrolled HTN
High Cholesterol (Low HDL/High LDL)
Sleep Apnea
Heart Disease � CHF, heart defects, heart infection abnormal heart rhythm
Personal Hx of stroke, MI or TIA
Race � African American are at high risk
Age older than 65
Gender � male higher risk however women who have stroke are more
likely to die than men
Risk with women � birth control, hormone replacement and child birth

What are the after affects of a left sided stroke?

Expressive aphasia �
Global aphasia
Agraphia � inability to write
Alexia � inability to read
Right hemiplegia (paralysis one side) or hemiparesis (weakness)
Right Homonymous hemianopsia (not able to past the midline)
Short term memory impairment

What are the after effects of a right sided stroke?

Paralyzed left side hemiplegia
spacial perceptual defecits
tends to minimize probs
short attention span
visual defecits
impaired time concept

What is the emergency treatment of a stroke?

Altepase (tPa)

What test is done immediately to distinguish between an ischemic
stroke and a hemorrhagic stroke?

CT you can see hemorrhagic stroke

What is the emergency treatment difference between an ischemic stroke
and a hemorrhagic?


Why is a lumbar puncture contraindicated in suspected ICP?


How soon are cerebral infarctions visible on a CT scan?

6-8 hrs after onset of symptoms

How soon is a hemorrhagic stroke visible on a CT scan?


What medications are given for ischemic stroke prevention?

cholesterol lowering drugs

What is Virchows Triad?

3 factors that contribute to thrombis
Endothelial injury Stasis or turbulence of blood
flow Blood hypercoagulability

What are the signs and symptoms for hydrocephalus?

Headaches. Nausea. Difficulty focusing the
eyes. Unsteady walk or gait. Leg weakness.
Sudden falls. Irritability. Drowsiness

What can cause hydrocephalus?

Spina Bifida,
bleeding within the brain,
brain tumors,
head injuries,
complications of premature birth such as hemorrhage, miningitis

Hydrocephalus can occur at any age, but is most
common in infants and adults age 60 and
older. ... Hydrocephalus is a
condition in which excess cerebrospinal fluid (CSF) builds up within
the ventricles (fluid-containing cavities) of the brain and may
increase pressure within the head.

What are early findings of ICP?

Change in LOC and respirations

What are the late findings of ICP?


What are possible causes of ICP?


What does decerebrate and decorticate posture indicate?

Decerebrate- mid brain and pons injury
Decorticate-worse- spinal tract or cerebral hemisphere

Why do we hyperoxygenate and ventilate patients with severely
increased ICP?


What is a normal ICP range?

The normal ICP is 5 - 15 mmHg

What is cerebral perfusion pressure and how is it measured and what
is normal?

Cerebral perfusion pressure, or CPP, is the net pressure gradient
causing cerebral blood flow to the brain.

What does more room in the cranial vault with older patients have to
do with symptoms of increased ICP going unnoticed at first?


What are the parameters for the Glasgow coma scale?

Eye opening (1-4) none, to pain, to stimuli, spontaneous
Best Motor Response (1-6) none, extensor response, abnormal flexion,
withdraws, localized, obeys
Verbal response (1-5) none, incomprehensible, innapropriate words,
confused conversation, orientated
Max 15
min 3

Pupillary responses mirror the status of what?

Midbrain and pons

Pressure on the brainstem compromises the function of cranial nerves
IX and X. these control what?

gag reflex and cough reflex

Why do vasospasms in the brain occur?


What are lacunar infarcts?

Lacunar stroke or lacunar infarct
(LACI) is the most common type of
ischaemicstroke, and results from the occlusion of
small penetrating arteries that provide blood to the brain's deep structures.

What is a TIA and its manifestations?


When are thrombotic strokes more likely to occur in older individuals
and why?


A TIA usually comes before a thrombotic stroke and is ______________
but its progression is _______________.


What happens during stroke-in-evolution?


When are embolic strokes more likely to happen and why?


IN an embolic stroke onset is sudden but is progression slow or fast?


why is some one who has had an ischemic stroke at risk for a
hemorrhagic stroke?


Which side of the brain is likely to have injury if the patient is
experiencing aphasia, alexia, dyslexia, agraphia, and acalculia?


What is ataxia?

gate disturbance

What is the result of a stoke that has affected the brain stem or cerebellum?