Coma and ICP Flashcards
Greatest danger in neurologic disease
Intracranial Pressure (ICP)
Progression of increased ICP
Headache
Vomiting
Decreased Sensorium
Herniation
Brain Death
Cushing Phenomenon
Increased ICP = Increased BP + Decreased HR
Relationship of ICP and sensorium
Inversely proportional
The higher the ICP, the lesser the sensorium and vice versa
Levels of Sensorium
Awake/Alert
Drowsy/Lethargic/Obtunded
Stupor
Coma/Unconscious
pressure of all substances in the cranium
Intracranial Pressure
The amount of blood flow that goes up the brain
Cerebral blood flow
amount of blood that enters the brain every minute
700 mL
power or force that drives blood into the brain
Cerebral Perfusion Pressure
Cerebral perfusion pressure formula
Systolic BP - ICP
relationship of ICP and systemic BP
Directly proportional
If ICP goes up, BP goes up and vice versa
Components of intracranial pressure
Brain parenchyma
Blood volume
CSF
Causes of increased brain parenchyma
cerebral edema
brain tumors
damaged neuron and glial cells
A complication of increased ICP
herniation
2 components of herniation to occur
opening
something that enters through the opening
common areas where herniation occurs
uncus of temporal lobe
tonsils of lower cerebellum
openings in the brain
tentorial notch
foramen magnum
where the diencephalon connects c the midbrain
tentorial notch
tonsils from the medial part of the cerebellum will come down and pass through the foramen magnum
tonsillar herniation
where the medulla connects with the cervical spinal cord
foramen magnum
signs of tonsillar herniation
decreased sensorium
apnea
icreased ICP
two-sided herniation
decreased sensorium
bilateral medial rectus palsy
bilateral dilating non-reactive pupils
one sided herniation
uncal herniation
intervals when are osmotic diuretics given
Q4 (every 4 hrs)
signs of uncal herniation
decreased sensorium
cn 3 damage
ipsilateral medial rectus palsy
ipsilateral non-dilating pupil
ipsilateral ptosis
additional factors of increased ICP
increased cerebral blood flow
hypercapnia (increased CO2)
Fever
hypervolemia - too much fluids
restlessness
interventions or controlling ICP
elevate head 15-30 degrees
control fever aggressively
ventilatory support
osmotic diuretics (mannitol and hypertonic saline)
dexamethasone
more flexible diuretic
hypertonic saline
diuretic that works well with vasogenic edema
mannitol
side effects of dexamethasone
bleeding in stomach
increased risk for infection
normal osmolality
280 mL
osmolality when using osmotic diuretics
1000-9000 mL
