Template:Increased ICP treatment: Difference between revisions
(Created page with "===Increased ICP Treatment=== #Ensure adequate sedation (prevent gag reflex) #IVF to goal MAP >80 (maintains cerebral perfusion) #Mannitol ##If SBP>90 ###If SBP>90 in adu...") |
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#Ensure adequate sedation (prevent gag reflex) | #Ensure adequate sedation (prevent gag reflex) | ||
#IVF to goal MAP >80 (maintains cerebral perfusion) | #IVF to goal MAP >80 (maintains cerebral perfusion) | ||
#Mannitol | #[[Mannitol]] | ||
# | #*If SBP>90 | ||
# | #**If SBP>90 in adults use hypertonic saline NaCl 5% 150ml over 10 min | ||
# | #*Reduces ICP w/in 30min; duration of action of 6-8hr | ||
# | #*Bolus 20% @ 0.25-1 gm/kg as rapid infusion | ||
# | #*Monitor I+O to maintain euvolemia | ||
#Hyperventilation | #Hyperventilation | ||
# | #*No longer recommended as prophylactic intervention | ||
# | #**Hyperventilation to PaCO2 <25 never indicated | ||
# | #*Brief course only recommended if impending herniation (i.e., Cushing reflex) | ||
# | #***Maintain PaCO2 28-35 (20 breaths/min) | ||
#Seizure | #[[Seizure]] | ||
# | #*Treat immediately | ||
# | #*Seizure prophylaxis reduces seizures but does not improve long-term outcomes | ||
#Goal CPP ~60mmHg | #Goal CPP ~60mmHg | ||
# | #*If MAP <80, then CPP<60 | ||
# | #**consider crystalloids or colloids (plasma if INR>1.3) | ||
# | #**[[phenylephrine]] 10-100mcg/min, or other [[pressors]] prn | ||
# | #**transfuse [[PRBCs]], Hb>7 | ||
Revision as of 07:01, 6 June 2015
Increased ICP Treatment
- Ensure adequate sedation (prevent gag reflex)
- IVF to goal MAP >80 (maintains cerebral perfusion)
- Mannitol
- If SBP>90
- If SBP>90 in adults use hypertonic saline NaCl 5% 150ml over 10 min
- Reduces ICP w/in 30min; duration of action of 6-8hr
- Bolus 20% @ 0.25-1 gm/kg as rapid infusion
- Monitor I+O to maintain euvolemia
- If SBP>90
- Hyperventilation
- No longer recommended as prophylactic intervention
- Hyperventilation to PaCO2 <25 never indicated
- Brief course only recommended if impending herniation (i.e., Cushing reflex)
- Maintain PaCO2 28-35 (20 breaths/min)
- No longer recommended as prophylactic intervention
- Seizure
- Treat immediately
- Seizure prophylaxis reduces seizures but does not improve long-term outcomes
- Goal CPP ~60mmHg
- If MAP <80, then CPP<60
- consider crystalloids or colloids (plasma if INR>1.3)
- phenylephrine 10-100mcg/min, or other pressors prn
- transfuse PRBCs, Hb>7
- If MAP <80, then CPP<60