Neurology Book

Traumatic Injury

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Increased Intracranial Pressure in Trauma

Aka: Increased Intracranial Pressure in Trauma, Increased Intracranial Pressure
  1. See Also
    1. Head Injury
  2. Differential Diagnosis
    1. Increased Intracranial Pressure Causes
  3. Pathophysiology
    1. Closed Head Injury with secondary Increased Intracranial Pressure
  4. Signs: Findings indicating management below
    1. Intracranial Pressure >15 mm
    2. Severe Closed Head Injury (GCS 8 or less)
    3. Cerebral edema
    4. Cushing Response
      1. Severe Hypertension
      2. Severe Bradycardia
      3. Severe Hypopnea
  5. Management: If indicted for findings as above
    1. Consider fluid restriction
    2. Hed of bed to 30 degrees
    3. Intubate and consider hypoventilation to pCO2 25-30 mmHg
    4. Mannitol 20%, give 0.25 g/kg (15-25 g) every 6 hours
      1. May repeat with Mannitol 1.0 g/kg (50-100 g) over 5 minutes
      2. Hold manitol for Hypotension, Hypernatremia with sodium >152 or Serum Osms >305
    5. Definitive management with Neurosurgery
      1. Ventriculostomy or
      2. Surgical decompression
  6. Precautions
    1. Sustained ICP > 20 mmHg is associated with worse outcomes (ischemia risk)

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