ICP Flashcards
How does ICP affect hemodynamics?
The wrong pressure in the brain reflects perfusion status
What is does ICP measure?
Pressure inside the skull
Normal range for ICP?
When do we typically begin to tx ICP?
Range is 5 - 15 mmhg
ICP is treated if it is above 20 mmhg
Your patients pressure device is on the left side of their head. What side of their body is there pressure issues on?
They will then have pressure problems on the right side
- opposites
What is more important: ICP or cerebral perfusion pressures (CPP)?
Cerebral perfusion pressure (CPP) - it is more accurate to the patient’s brain. You can have inflammation in the brain & fluid BUT you can still be perfusing. Now, if you don’t have perfusion - that’s a problem.
What are 3 essential components of the skull?
Brain tissue 10%
Blood 12%
Cerebrospinal fluid 78%
Defintion of CPP or cerebral perfusion pressure
Pressure needed to perfuse the brain
How to calculate CPP
Map - ICP = CPP
Normal range for CCP
Low amount? And its associations?
70 to 100 mmhg
Below 50 mmhg is associated with ischemia and neuronal death
T/F
You can revive dead brain tissue
False. Once it is gone, it is gone.
Where can ICP be measured in?
Ventricles
Subarachnoid space
Epidural space
Brain parenchymal tissue
(wherever the damage is and if there’s a bleed or build up of fluid)
Where does the pressure transducer need be reference to when measuring ICP?
Trachus (can use laser)
- foramen Monroe
What can increase ICP?
Bleeding Hydrocephaly Meningitis Trauma Coughing/baring Not having midline positioning
Gold standard for monitoring ICP route?
Ventriculostomy
You have a patient having ICP measured. What do you need to check in relation to the drainage bag?
Do you touch the dressing?
Check color and consistency of fluid.
We do not change dressings or manipulate it.
What will spinal fluid look like in a meningitis infection patient?
How do we test it for infection?
Cloudy sediment
Test it by doing a lumbar puncture
How can ICP be controlled/manipulated?
What needs to be monitored?
We can drain off CSF
But monitor volume and infection risk closely
How do you measure ICP? What do you record?
As a mean pressure at the end of expiration
What causes inaccurate ICP readings?
CSF can leak Catheter can be obstructed by sediment Kinks Incorrect height of drainage system relative to reference point - people move the bed Differences in height of bolt/transucer
Optimal range for CPP?
60 - 100
What do we want to drive for CPP?
Drive MAP (in order to have enough force to perfuse)
- vasopressors; dopamine high dose pressor
- fluids to follow
What do we want to minimize for CPP?
Try to minimize the ICP
How can we minimize the ICP?
Sedation
Osmotic agents - mannitol, 3% to pull of fluid
Ventriculostomy - pulls fluid to the abdomen
Vasopressors used for CPP
Dopamine
Norepinephrine
Neosynephrine
Vasopressin
Ask about CPP and renal doses lower than 3 mcg/kg
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