Increased ICP

Question 1

Increased ICP

CPP=

Answer 1

MAP - ICP

Question 2

Increased ICP

ASAP:

Answer 2

ABCs, IV, O2, monitor, VS

Question 3

Increased ICP

Hx/exam:

Answer 3

h/o trauma, h/o cancer, HA, N/V, szs, vision changes, dilated pupils, posturing, AMS, fundo exam for papilledema

Question 4

Increased ICP

Labs/Rads:

Answer 4

CBC, BMP, VBG, stat non-con head CT,   ocular US for ONSD

Question 5

Increased ICP

Tx:

Answer 5

Elevate head of bed 30 degrees
Call Neurosurgery to discuss the following interventions…
Intubate
Lidocaine- 1.5 mg/kg 3 min prior- no evidence
Fentanyl- 3 mcg/kg (if not hypotensive)
Hyperventilation to PCO2 26-30 mmHg (temporizing measure only)
Mannitol 1 gm/kg IV - Not shown to help
Hypertonic saline- 250 cc bolus q6hr prn goal Na 155
Phenytoin or Fosphenytoin 20 mg/kg IV
Dexamethasone 10mg IV
If intracranial bleed… correct coagulopathy if present

Question 6

Increased ICP

Tier 0 Tx:

Answer 6

Head of bed up, temp normal, PaCO2 35-38 mm Hg, control pain/sedate if intubated

Question 7

Increased ICP

Tier 1 Tx:

Answer 7

Osmotic therapy( mannitol, hypertonic saline, sodium bicar)

Question 8

Increased ICP

Tier 2 Tx:

Answer 8

Propofol drip, CPP optimization

Question 9

Increased ICP

Tier 3 Tx:

Answer 9

Decompressive craniectomy, induce hypothermia, pentobarb, moderate hyperventilation