Head Pressure Medications

Question 1

Elevated ICP therapies/meds

Answer 1

Raise head of bed
Hyperosmolar therapy
Hyperventilation to PCO2 of 35 (if actively herniating only )

Question 2

Hyperosmolar therapy meds

Answer 2

Mannitol
3% HTS

Question 3

Mannitol dose (elevated ICP)

Answer 3

1g/kg q6hr
- watch for HOTN 2/2 diuresis

Question 4

3% HTS dose (elevated ICP)

Answer 4

Adults:
- 250mL over 10 min then 50-100mL/hr
Peds: rule of 3’s (3mL/kg of 3% over 30 min)
- 2-5mL/kg over 30 min

Question 5

SAH/ICH BP goals?

Answer 5

SBP <140mmHg (institution dependent protocol)

Question 6

SAH/ICH medications

Answer 6

Nicardipine
Labetalol
Nimodipine
Clevidipine

Question 7

Nicardipine dose (SAH/ICH)

Answer 7

5-15mg/hr

Question 8

Labetalol dose (SAH/ICH)

Answer 8

10-20mg IV bolus q 3-5 min
Then
0.5-2mg/min

Question 9

Nimodipine dose (SAH/ICH)

Answer 9

60mg PO q4h (non-traumatic SAH only, started w/in 4 -21 days)
- likely not started in the ED
- can cause HOTN

Question 10

Clevidipine dose (SAH/ICH)

Answer 10

Start 1-2mg/hr