Acute intracranial problems Flashcards
Normal ICP
5-15mmHg, we do something at 20
CPP equation
MAP-ICP
two main causes of vasoconstriciton
increase in CO2 (decrease in pH) or decreased O2
Cushings triad
Widening pulse pressure, then decreased HR with FULL BOUNDING pulse, then decrease in RR
Why is the pulse in cushing triad full and bounding?
It’s not a fluid problem, but a pumping problem
Ipsilateral vs contralateral symptoms of increased ICP
change in pupils will be ipsilateral, while the motor function will be contralateral.
decorticate posturing signals injury to what
cerebral cortex injury
positioned with arms over chest
decerebrate posturing
means there is an injury to the brainstem (VERY bad)
Where do you position the transducer in ICP monitoring
Place at tragus of ear
how do you read the pressure with the transducer?
you want to close clamp 5-10 min before reading to ensure accuracy
Normal ICP waveform
Peaks decend from P1 P2 to P3
What will the waveform look like with increased ICP?
P2 wave will rise above the P1 peak
Which device allows you to measure temperature and oxygenation of the brain?
Licox, placed in the healthy white matter of the brain
-Can also measure SJVO2 (55-75%)
Range for PbtO2
20-40mmHg
Drugs used for increased ICP
rapid-acting opioids, propofol is also good
-dont use long lasting benzos
Mannitol
Used for increase ICP
-watch for massive fluid overload, monitor F/E closely
Hypertonic saline
also used for increase in ICP
common symptoms of coup/countercoupe injury
high BP, amnesia, HA
Most serious skull fracture
Basilar, example-ears, nose, around eyes
Why are basilar fractures most serious?
Can have high risk of meningitis
What medication do you give for a head injury for pain?
Only tylenol
What are impt signs of bacterial meningitis?
Kernig’s (flex hip, can straighten leg) and Brudzinskis (bend neck, knees bend) test
Why is viral meningitis better to have?
Usually mild and self-limiting
-give abx until confirmed that it is viral
Decreased LOC with ipsilateral fixed dilated pupil is a sign of what?
subdural hematoma
S/S of epidural hematoma
initial decrease in LOC, brief lucid period, then decrease LOC again. this is very bad
Dx of bacterial meningitis
purulent CSF. Labs have high protein, low glucose.
