ICP, Vasogenic Edema in Brain

Question 1

What steroid type and dose to give

Answer 1

dexamethasone IV

LD 10mg->then 8-16mg/day
-ex IV Dex 6mg Q6H

Doses as high as 40mg/day OK to give in Edema 2/2 Brain tumor

Question 2

Half Life of Dex

Answer 2

36-54hrs

Question 3

Causes of ICP/brain edema

Answer 3

Tumor

Stroke

Traumatic Brain Injury (TBI)

Question 4

Fluid/diuresis as therapy?

Answer 4

Hypertonic (3%) saline

Mannitol (osmotic diuretic)
-could add Lasix if tolerate BP

(Studies found Hypertonic saline more effective)

Question 5

Which ICP etiologies require steroids use

Answer 5

Edema from brain tumor

Infection of CNS

Question 6

When are steroids NOT used for ICP

Answer 6

ICH (intracranial hemorrhage)

Ischemic Stroke

Question 7

clinical signs of ICP

Answer 7

dilated pupils (papilledema on retina)

Severe HA

Bradycardia
HTN
Slow RR
(CUSHING TRIAD)