1.3 MTB Step 3 - Trauma (Elevated ICP)

Question 1

HISTORY OF PRESENTING ILLNESS

What are (3) Steps in the development of Elevated ICP?

Answer 1

1. Briefly Depressed Consciousness AFTER Head Trauma
2. Improvement
3. Progressive Drowsiness

Elevated ICP is a Medical Emergency

Question 2

DIAGNOSIS

What is an important Sign to look for in a patient with ICP as an indication of Clot Expansion?

Answer 2

Gradual Dilation of one Pupil and a Decreasing Responsiveness to Light

Clot Expansion is in the Ipsilateral Hemisphere as the Dilated Pupil (Same Side)

Question 3

DIAGNOSIS

What is the Best Diagnostic Test for Elevated ICP, and what will it show?

Answer 3

Head CT

Look for Midline Shift or Dilated Ventricles

Do NOT perform a lumbar tap in anyone without first getting a Head CT

Question 4

MANAGEMENT

What are (5) Management Steps for a patient diagnosed with Elevated ICP?

Answer 4

1. Head Elevation
2. Hyperventilation - causes vasoconstriction and decreased blood volume in the brain, lowering ICP.
3. Avoid fluid overload
4. Mannitol - use very cautiously; it can reduce cerebral perfusion.
5. Sedation and/or Hypothermia - these lower oxygen demand.

Question 5

MANAGEMENT

What is the Mechanism of Mannitol?

Answer 5

• Mannitol is filtered by the Glomeruli but not reabsorbed from the renal tubule.
• The result is Decreased Water and Na+ Reabsorption, which subsequently leads to decreased extracellular fluid volume.

CAUTION! Do NOT overdo the treatment for elevated ICP. Lowering ICP is NOT the ultimate goal; Preserving Brain Perfusion is.