Transcript Change or inequality in pupil size from baseline assessment is a

Medical Surgical Nursing II
Charnelle Lee, RN, MSN.
Student Copy
MS II Neuro Presentation
1
 Identify
the components of a neurologic history.
 Describe the five components of the neurologic
assessment.
 Discuss the neurologic changes associated with
intracranial hypertension.
 Identify key diagnostic procedures used in
assessment of the patient with neurologic
dysfunction.
 Discuss the nursing management of a patient
undergoing a neurologic diagnostic procedure.
MS II Neuro Presentation
2
MS II Neuro Presentation
3
 Normal
Cerebral function –
 Blood, cerebrospinal fluid, and brain tissue is
in equilibrium
 Brain substance – 80%
 CSF
-- 10%
 Blood
--10%
 Abnormalities occur when one of these
components increases, displaces or shifts.
 Normal ICP is ______ to _____ mm hg
MS II Neuro Presentation
4
 Brains
ability to
change diameter of
blood vessels to
maintain constant
cerebral blood flow
when systemic bp is
altered.
 Conditions that
maintain cerebral
perfusion
Arterial systolic blood
pressure is 50 to 150
 ICP is less than 40

MS II Neuro Presentation
5
 Cerebral
autoregulation,
 responsible for the control of cerebral blood
flow (CBF) is frequently lost with any type of
intracranial injury. (Urden, Stacy, & Lough,
2012, p. 347)
 Compensation
 Bodies goal to keep cerebral blood flow
stable to prevent brain injury
 This leads to a discussion of the Monroe
Kelle’ Hypothesis
MS II Neuro Presentation
6
 Increase
in volume of one intracranial
component must be compensated by
decrease in one or more of the other
components so that total volume remains
fixed


Volume-pressure curve
Cerebral blood flow and autoregulation
 Cerebral
blood flow and cerebral blood
volume increase in an attempt to maintain
cerebral perfusion which increases ICP.
 Increases in ICP cause brain injury if the ICP
is not controlled
 Treatment Goal
 Control system hypertension without creating
hypoperfusion
MS II Neuro Presentation
8
 Decrease
in oxygen
resulting in the
failure to nourish
the tissues at the
capillary level.
 In order to restore,
maintain cerebral
perfusion a nurse
needs to recognize
that the risk for this
problem exists.
MS II Neuro Presentation
9
 CPP
= MAP – ICP
 Only directly measurable with an intracranial
pressure monitoring device.
 Clinical assessment findings can point
towards CPP alterations
 Normal CPP is 80 to 100 mmhg
 Blood flow ceases when CPP=MAP
 Neuronal ischemia and death occurs with a
CPP <30 mm hg
MS II Neuro Presentation
10

Signs and symptoms of increased ICP:



Unequal pupil size
Projectile vomiting
Decreased pupillary reaction to light
Altered breathing patterns
 Headache

(continued)
MS II Neuro Presentation
12
 Prompt
treatment to prevent secondary
insults
 General number – ICP must be treated if it
is greater than 20 mm hg
 Goal of therapy #1




Reduction of one or more of the 3 components
that lie in the intracranial vault
1.
2.
3.
MS II Neuro Presentation
13
 Radiologic


procedures
Skull and spine films
Computed tomography
(CT)
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
14
 Radiologic
procedures
(Cont.)

Magnetic resonance
imaging (MRI)
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
15
 Radiologic
procedures
(Cont.)

Cerebral angiography
 Conventional
angiography
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
16
 Radiologic
procedures
(Cont.)

Myelography
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
17
 Electrophysiology


studies
Electroencephalography (EEG)
Evoked potentials
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
18
 Cerebrospinal


fluid (CSF) analysis
Lumbar puncture
Cisternal puncture
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
19
 Goal of therapy #2

Determine the cause of the
elevated ICP

If possible remove the cause

In the absence of a surgically
treatable mass lesion,
intracranial hypertension is
treated medically.
MS II Neuro Presentation
20
 Rapid
Assessment
 Implementation
of
ICP reduction
therapies
MS II Neuro Presentation
21


Obtain a thorough history
of events preceding the
onset of hospitalization
Interview the patient if
possible or those closest to
the patient about
 Symptoms
 Precipitating factors
 Progression of symptoms
 Family history
MS II Neuro Presentation
22

Five Major
Components

Level of consciousness
Arousal evaluation
 Awareness appraisal
 GCS





Motor function
Pupillary function and
eye movement
Respiratory patterns
Vital signs
MS II Neuro Presentation
23
 Affect,
alertness, hygiene, ability to
speak, move, contractures,
 Alert, oriented, and to what degree. Check
pupils for size, are they equal?
 Can they follow commands?
 Check the Babinski reflex if applicable.
 Check hand grasps, leg rises alone or
against pressure. Cranial nerves III, IV, VI,
move the eyes in all 6 cardinal areas
 Do DTR’s & clonus if applicable. List cranial
nerves 1 – 12, noting deficits if present.
MS II Neuro Presentation
24
•
Level of
Consciousness (LOC)
•
Arousal
•
Awareness
•
Categories of
Consciousness
•
Alert
•
Lethargic
•
Obtunded
•
Stuporous
•
Comatose
MS II Neuro Presentation
25


A 54 year old female patient is brought to the ER
unconscious. The patient’s airway is selfmaintained, oxygen is currently in place 100%
NRB. The patient does not respond to noxious
stimuli. The EMS staff have an IV line in the right
forearm with Normal Saline at 25 ml/hour. What
Level of Consciousness would this patient be at?
•
Alert
•
Lethargic
•
Obtunded
•
Stuporous
•
Comatose

Next gentlement presents to the ER after having a
grand-mal seizure. The patient is post – ictal but
responds to a sternal rub by hitting at the arm of the
examiner. The patient has a history of alcoholism.
The patient has stertorous (harsh, noisy breathing
usually heard in a comatous patient) respirations, sat
of 72% on 100% non-rebreather, heart rate is 92 sinus
with pvc’s. What Level of Consciousness would this
patient be at?
•
•
Alert
Lethargic
•
Obtunded
Stuporous
•
Comatose
•
•
•
•
•
Most important part of the neurological exam
LOC deteriorates before any other
neurological changes are noted in most cases
Changes can be subtle
Listen to your intuition
MS II Neuro Presentation
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Lowest level of
consciousness
 Centers ability to respond
to verbal or noxious
stimuli
 Nursing Assessment:
 Begin with verbal
assessment in a normal
tone
 Stimuli increase if the
patient does not respond
– shouting
 Shaking
 Noxious stimuli

MS II Neuro Presentation
29
•
•
•
Higher level function
Assessment of the person’s orientation to
person, place and time
Changes in the patient’s answers to a
variety of questions that are
inappropriate and indicate increasing
degrees of confusion and disorientation
may be the first sign of neurological
dysfunction
MS II Neuro Presentation
30
•
•
•
•
•
•
•
•
•
Most widely recognized evaluation tool for
neurological status
Eye opening
Verbal response
Best motor response
Lowest score 3
Highest 15
Just part of the process not a complete
assessment tool
Page 343
What limitations are associated with this
evaluation tool?
MS II Neuro Presentation
31
•
Motor Function
•
Motor assessment
techniques
•
Verbal stimuli
•
Noxious stimuli
•
•
•
•
Acceptable vs.
Unacceptable techniques
Central Stimulation
Peripheral Stimulation
Levels of motor movement
•
Evaluate each extremity
separately
•
Motor strength
•
Glasgow Coma Scale best
motor response
MS II Neuro Presentation
32
MS II Neuro Presentation
33

Motor function
Evaluation of muscle size and tone
◦ Estimation of muscle strength
◦ Abnormal motor responses
 Evaluation of reflexes
 Deep tendon reflexes (DTRs)
◦
MS II Neuro Presentation
34
•
•
•
•
•
•
Involves the application
of noxious stimuli
Abnormal Flexion –
decorticate
Lesions above the midbrain in the thalamus
and cerebral
hemispheres
Abnormal extension –
decerebrate
Teeth clench, arms/legs
are extended
Occurs with lesions in the
area of the brain stem
MS II Neuro Presentation
35
 Upper
Extremities are
used to determine
which type of posturing
is being exhibited?
 Which
one of these
postures do you think
is the worst as far as
patient outcome?
MS II Neuro Presentation
36
Next gentlemen presents to the ER after having a
grand-mal seizure. The patient is post – ictal and
initially responded to a sternal rub by hitting at
the arm of the examiner. The patient 2 hours
later demonstrates decorticate posturing only to
a sternal rub. What is happening to this patients
 Level of Consciousness?
 Describe what the examiner sees when
decorticate posturing occurs?
 Nursing Action Indicated:
 Nothing
 Call physician
 Place patient on seizure precautions

MS II Neuro Presentation
37
Estimating pupils size
and shape
• Evaluating pupil reaction
to light
• Assessing eye
movements.
•
MS II Neuro Presentation
38

Pupillary Function and Eye
Movement


Anatomy of pupillary
response

CN II

CN III
Assessment of pupillary
response

Size

Shape

Reaction to light

Direct pupillary response
to light (CN III)

Consensual pupillary light
response (CN II)
MS II Neuro Presentation
39
 Correct
technique
 Narrow beamed
bright light shined
into the pupil from
the outer canthus
of the eye.
MS II Neuro Presentation
 Pupillary
reaction
terms
 Brisk
 Sluggish
 Non-reactive
40
•
•
Documented in millimeters using a pupil
gauge
Discrepancy of up to 1mm between pupils is
normal
•
Anisocoria
• Pupil inequality which - occurs as a normal
finding in 16 to 17 percent of the population
•
MS II Neuro Presentation
41
•
Change or inequality in pupil size from
baseline assessment is a significant
neurological sign in those patient’s who
have not previously shown this
discrepancy.
•
Indicates – impending danger of
herniation
•
Report Immediately
MS II Neuro Presentation
42
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
43
•
Normal Shape is
round
•
Oval Shape or irregularly
shaped pupil often noted
in patient’s with elevated
Intracranial Pressure
•
Oval Pupil associated
with ICP levels of 18
to 35 mm hg.
MS II Neuro Presentation
44
 Interaction
of
three cranial
nerves
 Oculomotor (CN
III)
 Trochlear (CN IV)
 Abducens (CN VI)
 Pathways located
in the brain stem
MS II Neuro Presentation
45
•
•
•
•
Used in the conscious
patient
Assesses the three
cranial nerves
In the unconscious
patient ocular
function is assessed
by eliciting the doll’s
eyes reflex
Must have spinal cord
cleared of injury if
coma is related to
injury before this test
is performed
MS II Neuro Presentation
46
MS II Neuro Presentation
47



Performed by a physician
Usually a last ditch
assessment to determine
the extent of brain stem
function
Before this test is
performed assess tympanic
membrane condition –
needs to be intact

HOB - @ 30 degrees

20 to 100 ml of ice water is
injected into the external
auditory canal
MS II Neuro Presentation
48
 Part
of the process not the whole indication
of brain stem function
 Metabolic Encephalopathy will cause these
reflexes to be absent
 May produce posturing in some patients
 In a conscious patient will induce nausea,
vomiting and dizziness
MS II Neuro Presentation
49
MS II Neuro Presentation
50
 Potential








causes
Increased Intracranial pressure
Consequence of neurological procedures
Seizures
Head Injury
Electrolyte imbalance
Hypoxia
Shock
Disease
MS II Neuro Presentation
51
 Change
in _________ of _____________
MS II Neuro Presentation
52
 __________
of speech
 Delay in response to __________ suggestions
MS II Neuro Presentation
53

Changes may be very subtle and progress as alteration
continues

1. Behavior – anxiety/restlessness/periods of disorientation
with rapid return with reorientation

2. Pupils will be sluggish

3. Patient may then progress to unresponsiveness, pupils
non-reactive
MS II Neuro Presentation
54
 Signs
and symptoms of increased ICP:

Decreased level of consciousness






One of the earliest signs
Cushing’s triad
Diminished brainstem reflexes
Papilledema
Decerebrate posturing (abnormal extension)
Decorticate posturing (abnormal flexion)
(continued)
 Three
clinical manifestations
 Bradycardia
 Systolic Hypertension
 Widening Pulse Pressure
 Cause


Pressure on the medullary area of the brain stem
Occur in response to increased ICP or a
herniation syndrome
MS II Neuro Presentation
56
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
57
 Rapid


neurologic assessment
The conscious patient
The unconscious patient
 Neurologic
changes associated with
intracranial hypertension
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
58
 Early

Tachycardia
 Mid


– stages of increasedICP
Dysrthymias with the tachycardia
Types of rhythm problems – PVC’s, AV Block, Vfib, myocardial damage
 Late

stages of increased ICP
stage of increased ICP
Bradycardia
MS II Neuro Presentation
59
 Respiratory





Patterns
Control of Respirations- Complex system
Very similar to cardiac cell automaticity
If a higher level of function is damaged the one
next in line will kick in
Manager of respiratory function – cerebral
cortex, diencephalon
Under these two are the 3 brain stem centers

Medulla – Pons (apneustic and pneumotaxic centers)
MS II Neuro Presentation
60
 Medulla
– sends impulses through the vagus
nerve to innervate muscles of inspiration and
expiration
 Apneustic and Pneumotaxic Centers (Pons)

Responsible for the length of inspiration and
expiration as well as the underlying respiratory
rate
MS II Neuro Presentation
61
•
•
•
•
Changes in these
patterns provide clues
to where the level of
brain injury is
Evaluate gas
exchange during this
assessment
Hypoventilation –
common in patients
with brain injury
Intracranial pressure
increases in situations
of hypoxemia and
hypercapnia.
MS II Neuro Presentation
62
 Assess
the patient’s ability to protect their
airway throughout patient care.
 Assess ability to swallow
 Control
 Cough
secretions
and gag reflexes
MS II Neuro Presentation
63
 Head
positioning
 Body positioning
 Oxygen
 Intubation
 Mechanical Ventilation


Neurological Compromise requires emergent
intubation earlier rather than later
GCS of 7 or less requires intubation in most cases
MS II Neuro Presentation
64
 Arterial
blood gases exert a powerful effect
on CBF.
 CO2 is a potent vasoactive substance
 CO2 hypercapnia – results in cerebral
vasodilation – leading to increased cerebral
blood volume
 CO2 hypocapnia – leads to cerebral
vasoconstriction – leading to reduction in
cerebral blood volume.

Prolonged hypocapnia can lead to cerebral tissue
ischemia.
MS II Neuro Presentation
67
 Low
arterial partial pressure of oxygen
(PaO2) levels especially below 40 mmhg
 Leads to vasodilation
 WHICH LEADS TO INCREASED ICP
 High PaO2 levels have NOT been shown to
affect CBF in either way.
MS II Neuro Presentation
68
 Describe
the medication given to intubate
the patient that was described to eliminate
increasing the ICP during the intubation?
What is the dose and the time period before
intubation to give this drug?
MS II Neuro Presentation
69
 http://www.med.umkc.edu/em/resources/In
tubation_Chart.pdf
 Meds to know are:
 Propofol
 Fentynl
 Lidocaine
 Etomidate
 Rocuronium, Succinylcholine, Vecuronium
MS II Neuro Presentation
70
 Which
are the nursing implications of
pharmacologic paralysis?
 Airway Implications
 Monitoring equipment
 Analgesic and sedative administration
MS II Neuro Presentation
71

In the film mannitol
was given for what
reason?

What is the dose
recommended in your
Text?

When giving Mannitol
what must be done
before drawing it up?

How does Mannitol
work?
MS II Neuro Presentation
72
 Swan
in the Brain
 Placed in Several Different Locations of the
Brain structures
 Purpose




Assess the level of ICP
Monitor trends
Manage Intracranial Hypertension
Draining of CSF fluid for sample or to decrease
pressures (some do, some don’t)
MS II Neuro Presentation
73
Subarachnoid Space
Placing a small hollow bolt or
screw into the subarachnoid space
Easier to insert
MS II Neuro Presentation
74





Big risk of infection
Ventriculostomy is the one
that presents the biggest risk
of infection
Maintain patient sedation
with ICP monitoring
If they are agitated and
restless readings will not
reflect truth
Recalibrate just about every
time you need to take a
reading.
MS II Neuro Presentation
75

Intraventricular Space
Known as a
ventriculostomy
 Inserted through a
Burr Hole
 Local Anesthesia
 Side chosen is the
non-dominant side

MS II Neuro Presentation
76

Subarachnoid Space
Placing a small hollow
bolt or screw into the
subarachnoid space
 Easier to insert


Epidural Space


Placing a small
fiberoptic sensor into
the epidural space
Parenchyma

Placed into the white
matter of the brain
MS II Neuro Presentation
77
 Positioning
 Hyperventilation
 Temperature
control
 Bp
control
 Seizure control
 CSF drainage
 Hyperosmolar Therapy
 Control of metabolic demand
 Draining of CSF
MS II Neuro Presentation
78

Medical and nursing management (Cont.)
Hyperosmolar therapy
 Osmotic diuretics
 Hypertonic saline

Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
79

Medical and nursing management (Cont.)
Control of metabolic demand
 Benzodiazepines
 Intravenous sedative–hypnotics
 Opioid narcotics
 Neuromuscular blocking agents
 Barbiturate therapy

Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
80






A patient with a TBI related to a two car motor vehicle
accident is in the emergency room being assessed by the
physician. On arrival the patients glascow coma scale was
12. The patient has a 100% non-rebreather in place. On
reevaluation the patients Glascow coma scale has
decreased to 7. ABG's are drawn with the following results:
Ph:7.33 PCO2 55 PO2 55 HCO3- 24.
Describe this neurological assessment and abnormals seen.
Interpret the ABG:
Describe what the patient looks like with a GCS of 7 that
decreased from a 12.
Airway management – of the following: OPA, NPA,
Intubation which would be required.
Nursing Diagnosis MS II Neuro Presentation
81

A patient is in a deep barbituate coma after severe head trauma.
The patient is intubated and is receiving mechanical ventilation.
The patient has a ventriculostomy for intracranial pressure
monitoring. The nurse listens to lung sounds and ausculates
rhonchi throughout the upper anterior lobes. The patient vital
signs are temperature of 99'F, heart of 78, ventilator rate of 12
with no assist from the patient, blood pressure of 123/70, oxygen
saturation of 92%. The patient's ICP reading is averaging 10 to 12
mm hg. Nursing action would be:

(a) Document the finding as the only action

(b) Administer an ordered dose of Mannitol for the patient's
symptoms of fluid overload

(c) Hyperoxygenate the patient and suction endotracheally

(d) Notify the physician
MS II Neuro Presentation
82





A nurse is caring for a head injured patient with
intracranial pressures of 20 to 30 mm hg. The patient is on
barbituate therapy to decrease refractory intracranial
hypertension. The following vital signs are obtained a core
temperature of 101F, heart rate of 94, ventilator rate of
12, blood pressure of 120/60. Blood gas results are 7.37,
PCO2 of 35, PO2 of 95, HCO3- of 24. Nursing priority action
would be
(a) Ask family members to leave the patient is being
overstimulated.
(b) Administer tylenol for hyperthermia.
(c) Document the finding as the only action.
(d) Call the physician to increase the breathing rate on the
ventilator to treat hypercarbia and acidosis.
MS II Neuro Presentation
83

A patient admitted with a closed head injury is sedated and is on a
mechanical ventilator till their intracranial pressure stabilizes. The
patients blood gases are Ph of 7.40, PCO2 of 50 mmhg, PO2 of 85 mm Hg,
and a HCO3 of 24mm hg. The patient has a blood pressure of 150/98,
pulse of 72, ventilator rate of 12 breaths per minute and a temperature
of 98.7mmhg. The patients CVP reading is 4 mm hg and their intracranial
pressure monitor reads 20mmhg. The nurse caring for this patient would
implement which of the interventions listed below in order to preserve
cerebral blood flow?

(a) Call the physician for an increase in the FiO2 to 100% for one hour.

(b) Administer a tylenol suppository to decrease metabolic demand.

(c) Call the physician for an order for mannitol to decrease the patients
intracranial pressure.

(d) Call the physician to increase the ventilator rate to decrease the
carbon dioxide level.
MS II Neuro Presentation
84
 A nurse is caring for a patient who is intubated and sedated post surgery
for a brain tumor. The nurse gathers the following assessment data b/p of
80/30, heart rate of 81 and a sinus rhythm, respiratory rate of 14, sat of
95%. The patient has a pulmonary artery catheter in with a CVP of 10,
wedge pressure of 14. The patient has an IV of D5LR at 200ml/hour with
a urine output of 60 ml/hour. The patients cerebral perfusion pressure is
low. The physician has ordered that the patients systolic blood pressure
be maintained greater than 140 mm/hg. The nurse would initiate which
of the following orders.

(a) Hold the patients analgesic scheduled for this hour.

(b) Administer 1000 ml bolus of 0.9% saline.

(c) Dopamine at 5 to 10 ug/kg/min

(d) Administer Mannitol..
MS II Neuro Presentation
85





A patient with a head injury has an ICP monitoring device
in place. Orders are written to maintain the cerebral
perfusion pressure greater than 60 mm hg. The patient is
ventilated, with a central line, foley catheter, nasogastric
tube to low intermittent suction. Vital signs are
temperature of 98.8, pulse of 88, ventilator rate of 12,
and a blood pressure of 120/70.The patient has a CVP of
12. The patients ICP reading is 30 mm hg. Calculate the
CPP and pick the best intervention.
(a) start nipride at 5 ug/kg/min
(b) administer a 500 ml normal saline fluid bolus.
(c) administer mannitol.
(d) administer acetaminophen 650 mg per suppository.
MS II Neuro Presentation
86
 Clinical


assessment
A neurologic history includes information about
clinical manifestations, associated complaints,
precipitating factors, progression of symptoms,
familial occurrences, and events preceding the
onset of symptoms.
The five major components of a neurologic
examination are evaluation of: 1) level of
consciousness, 2) motor function, 3) pupillary
function, 4) respiratory function, and 5) vital
signs.
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
87
 Clinical



assessment (Cont.)
Assessment of the level of consciousness focuses
on evaluation of arousal and appraisal of
awareness.
Assessment of motor function focuses on the
evaluation of muscle size and tone and
estimation of muscle strength.
Assessment of pupillary function focuses on
estimation of pupil size and shape, evaluation of
pupillary reaction to light, and appraisal of eye
movements.
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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 Clinical



assessment (Cont.)
Assessment of respiratory functions focuses on
observation of respiratory pattern and evaluation
of airway status.
Assessment of vital signs focuses on evaluation of
blood pressure and observation of heart rate.
Increasing ICP can be identified by changes in the
level of consciousness, pupillary reaction, motor
response, vital signs, and respiratory patterns.
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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 Diagnostic



procedures
Radiologic procedures are performed to identify
abnormalities. Tests include radiography, CT, MRI,
cerebral angiography, and myelography.
Imaging of CBF and metabolism helps define cause
and extent of injury, identify treatments, and predict
outcome. Tests include perfusion CT, xenon CT,
perfusion MRI, carotid duplex sonography, PET, and
SPECT.
Electrophysiology studies are performed to evaluate
the electrical impulses of the brain. Tests include
EEG, VERs, BAERs, SSERs, and MEPs.
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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 Laboratory

CSF analysis is performed (by lumbar puncture or
ventriculostomy) to look for the presence of
blood or infection in the subarachnoid space
 Multimodal

studies
monitoring
ICP monitoring is used in patients with suspected
intracranial hypertension. Pupillometry and NPi is
a new technique for trending increased ICP. ICP
measurement allows for an estimation of CPP.
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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 Multimodal



monitoring (Cont.)
CBF monitoring is important for neurologic care,
because the brain depends on continuous blood
flow to supply glucose and oxygen. TCD, TCCS,
TDF, and LDF are techniques to monitor CBF.
Measurements of brain oxygenation and
metabolism aid in understanding acute brain
injury and ways to manage secondary brain
injury. Techniques include SjvO2, NIRS, PbtO2,
and cerebral microdialysis.
cEEG is used to detect seizures and ischemia.
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