Complex Exam 3 - intracranial regulation Flashcards
What is a normal ICP?
5/10-15 mmHg
What is a normal CPP?
60/70-95/100
How is CPP calculated?
MAP-ICP
What is a normal MAP?
70-100
How is MAP calculated?
3
How should the HOB be to decrease ICP?
at least 30
What can increase ICP?
- hypercarbia
- suctioning
- coughing, vomiting
- neck or hip flexion/extension
- increased abdominal pressure
- hyperthermia
How can ICP be decreased?
- keeping the body midline
- maintaining a patent airway and c-spine
What are the earliest signs of increased ICP?
- altered LOC: confusion
- altered respirations: cheyne-stokes
What are the characteristics of the eyes with increased ICP?
- uneven pupils (larger on the side of injury)
- double or blurred vision
- sluggish progressing to fixed
Where does weakness or paralysis occur with increased ICP?
on the opposite side of the injury
What posturing is a late sign of increased ICP?
decorticate or decerebrate
What does Cushing’s triad consist of?
- severe HTN with widening pulse pressure
- decreased HR and RR
What can be done to monitor ICP?
- bolts
- ventriculostomy
What is the ideal blood pressure of someone with increased ICP?
slight HTN
What does a ventriculostomy do?
- monitor ICP
- drain CSF
What surgical procedure can be done for increased ICP?
craniotomy
What PaO2 level should be maintained?
> 60
What PaCO2 level should be maintained?
30-45
How can CO2 be blown off in an intubated patient?
hyperventilate, speed up RR
What does mannitol do?
pulls fluid off the brain
Can mannitol be given to patients with renal disease, anuria, or cerebral hemorrhage?
NO
How long does mannitol take to go into effect?
15-30 mins
What does hypertonic saline do?
moves water out of edematous brain cells
What is phenobarbital used for?
decreased ICP and edema
What are corticosteroids used for?
to decrease inflammation and edema
What anti-seizure medications can be given?
phenytoin and lorazepam
Why might opioids or sedative meds be ruled out for neuro patients?
- respiratory depression
- decreased level of consciousness
- pupillary changes
Can you drain a lot of CSF from a ventriculostomy at once?
NO
