Neuro Yawn

[MagpieCCRN]

I am a new critical care nurse. I am taking care of my first "brain dead" patient. She isn't completely brain dead, she responds to painful stimuli, etc. I guess you could say she is a "vegetable".

The nurse giving me report said she had a "neuro yawn". And yes, my patient does yawn... but what exactly is a neuro yawn? Anyone know? Or is it just like a habit or reflex to something?

Thanks!!

[dscrn]

yawning occurs when increase in O2 is needed,,,

[fiveofpeep]

ahh and what about the neuro hiccups? I had a patient with continuous hiccups on the vent and every time he would hiccup it would trigger a respiration and the vent was always alarming. it drove us all crazy. is there a med to inhibit that?

I heard that yawning and hiccups in the neuro pt reflect increased ICP.

[GilaRRT]

Nobody really knows the exact mechanisms behind yawning. Many theories exist but nothing definitive that I am aware of.

Many medications including Zofran and Droperidol can be used for hiccup treatment. I know of some case studies where nefopam was used on refractory hiccups with success. It sounds like your patient was in AC, was another mode considered such as SIMV or PS ventilation? Assuming AC, it does not sound like you were looking at extubation anytime soon, as backing off on sedation when looking at liberation from the vent can be a cause of hiccups.

[dmc_rrt]

I noticed when I suction my vegatative trach pts that it also seems to trigger a yawn.

[fiveofpeep]

Many medications including Zofran and Droperidol can be used for hiccup treatment. I know of some case studies where nefopam was used on refractory hiccups with success. It sounds like your patient was in AC, was another mode considered such as SIMV or PS ventilation? Assuming AC, it does not sound like you were looking at extubation anytime soon, as backing off on sedation when looking at liberation from the vent can be a cause of hiccups.

He was in AC and he was not sedated. I was thinking that we should have tried a different mode too because it was the hiccups initiating the extra breaths that was causing the tachypnea. He ended up getting better within a few days and was extubated within a week.

[scoochy]

ahh and what about the neuro hiccups? I had a patient with continuous hiccups on the vent and every time he would hiccup it would trigger a respiration and the vent was always alarming. it drove us all crazy. is there a med to inhibit that?

I heard that yawning and hiccups in the neuro pt reflect increased ICP.

When I cared for open heart patients, I occasionally had a pt. with intractable hiccoughs d/t chest tubes. Solution: Thorazine 30-50 mgm IM. Not 100% effective, but it did work in some cases. As for yawning:

1. Yawning is a physiologic mechanism in response to an increase in C02. With an increase in C02, ICP increases. If you have ever cared for a trauma patient with a bolt in the subarachnoid space to measure ICP, a quick fix to decrease ICP and therefore counteract vasodilation in the brain is to hyperventilate the patient with an ambu bag or sighs on the ventilator. Yawning is comparable to a sigh on a ventilator; i.e., a deep breath.

[GilaRRT]

Actually, the physiology of yawning is not well understood.

Hyperventilation is a Peter and Paul situation in the setting of intracranial pathology.

[Zookeeper3]

We use thorazine as well, it certainly decreases the frequency and strength of the hiccups.

I personally have never found a neuro yawn to be related to an O2 need.

[PostOpPrincess, BSN, RN]

Why didn't you ask the nurse giving you report what it was?

[locolorenzo22, BSN, RN]

I work neuro, and many times in a post craniotomy patient I see yawns, and often a increase in their ICP right before said yawn....not sure what's going on there, or the relationship, but I see the clinical correlation.

[cmonkey]

Many medications including Zofran

Zofran for hiccups? Really? How does that work? I've only seen it taken (and taken it) for nausea.