Template:Increased ICP treatment: Difference between revisions
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===[[Increased ICP]] Treatment=== | ===[[Increased ICP]] Treatment=== | ||
#Elevate HOB 30 degrees (or reverse Trendelenburg position) | #Elevate HOB 30 degrees (or reverse Trendelenburg position) | ||
#IVF to goal MAP >80 (maintains cerebral perfusion) | #IVF to goal MAP >80 (maintains cerebral perfusion) | ||
#[[Mannitol]] | #[[Mannitol]] | ||
| Line 18: | Line 17: | ||
#*Seizure prophylaxis reduces seizures but does not improve long-term outcomes | #*Seizure prophylaxis reduces seizures but does not improve long-term outcomes | ||
#If need for [[RSI]], consider pretreatment with lidocaine and/or fentanyl | #If need for [[RSI]], consider pretreatment with lidocaine and/or fentanyl | ||
#*Also ensure adequate sedation (prevent gag reflex) | |||
#Goal cerebral perfusion pressure (CPP) ~60mmHg | #Goal cerebral perfusion pressure (CPP) ~60mmHg | ||
#*If MAP <80, then CPP<60 | #*If MAP <80, then CPP<60 | ||
Revision as of 20:05, 11 June 2015
Increased ICP Treatment
- Elevate HOB 30 degrees (or reverse Trendelenburg position)
- 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
- If need for RSI, consider pretreatment with lidocaine and/or fentanyl
- Also ensure adequate sedation (prevent gag reflex)
- Goal cerebral perfusion pressure (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