27. Increased ICP Flashcards
Normal ICP
5 to 15 mmHg or
100 to 200 mmH20
Value for increased ICP?
> 20 mmHg lasting for 5 mins or more
S/Sx of Increased ICP
Severe headache, nausea/vomiting, alteration in sensorium, lethargy
CUSHING’S REFLEX (bradycardia, hypertension, hypopnea)
DIPLOPIA
PAPILLEDEMIA (+) optic cup swelling, blurred disk margins
Mechanical Treatment of
POSITIONING: Elevate head at 30 degrees to optimize venous drainage. Keep neck neutral and prevent kinking of the internal jugular vein for drainage
MECHANICAL VENTILATION: Controlled Hyperventilation via mechanical ventilation can rapidly decrease ICP through vasoconstriction
Medical management of inc. ICP
Mannitol - A hyperosmotic agent which draws water from the brain & induces diuresis
Decreases pressure over 10-20min
Initial dose: 1-2g/kg
Maintenance: 50-300mg/kg q6
Dexamethasone - Effective against inceased ICP brought about by vasogenic edema from brain tumor, surgery & radiation
Initial dose: 5-25mg/IV
Maintenance: 2-8mg/IV q6
Control hyperglecmia & give antipyretics for fever (since both fever & hyperglycemia can increase metabolic demand & blood flow hence increase ICP) and anticonvulsants to prevents seizure, sedate the patient if restless
Give the patient oxygen, fluids (PNSS) and maintain a normal blood pressure
Mannitol
Dosage of Mannitol
LD: 1-2g/kg over 10-20 mins
MD: 50 to 300 mg/kg q6
Dosage of Dexamethasone
We could start with
ID: 5 to 25 mg/IV
MD: 2 to 8 mg/IV q6
Surgical Intervention for Inc ICP
Acute Hydrocephalus due to SAH/posterior fossa tumor/mass and meningitis - CRANIOTOMY for VENTRICULOSTOMY
Craniotomy could be used to evacuation of the cause
This could also lead to decompression
Patients with hypothermia and comatose may be admitted to the Intensive Care Unit for continuous ICP monitoring
Remember to treat primary disorders ASAP
How do you measure ICP
Intraventricular catheter is drilled into the skull toward the lateral ventricle to measure ICP
