Chapter 28

Question 1

signs of Intracranial pressure (ICP)

Answer 1

Intracranial pressure (ICP) is the pressure within the cranial vault. 
Increased ICP squeezes the brain against bony prominences within the cranium. 
Signs of increased intracranial pressure include: 
Cheyne-Stokes respirations (reHyperventilation should be reserved for specific conditions and performed under specific guidelines.

Question 2

hyperventilation

Answer 2

Hyperventilation is controversial because it can increase the severity of head injuries; avoid it except in cases where signs of brainstem herniation have been identified.
Use hyperventilation with caution and only when capnography is available to ensure an end-tidal carbon dioxide (ETCO2) level between 30 and 35 mm Hg.spirations that are fast and then become slow, with intervening periods of apnea)

Question 3

Transport of head injuries

Answer 3

In supine patients, the head should be elevated 30 degrees, if possible, to help reduce ICP.

Question 4

GCS

Answer 4

Question 5

Cushing Triad

Answer 5

Signs of Cushing triad include:

Increased blood pressure (hypertension)

Decreased heart rate (bradycardia)

Irregular respirations such as Cheyenne-Stokes respiration and Biot respiration

Cushing triad is also referred to as a herniation syndrome.The intracranial pressure is so great that it forces the brain stem and the midbrain through the foramen magnum.

If this process continues, it is fatal.

If the patient exhibits these signs, it is commonly acceptable to perform controlled hyperventilation of your patient via positive-pressure ventilations at a rate of 20 breaths/min for adults.

If capnography monitoring is in place, deliver assisted ventilations to target a goal ETCO2 level of 30 to 35 mm Hg.

Follow local protocols and your medical direction in regard to hyperventilation in the presence of herniation.