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Concepts in Critical care > Intracranial Pressure Monitoring > Flashcards

Intracranial Pressure Monitoring Flashcards

1
Q

If a needle were going to pass through the skull to the brain, what layers would it pass through on its way?

A

Dura mater
Arachnoid mater
Subarachnoid space
Pia mater

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2
Q

What is the function of the ventricles in the brain?

A

Production, transport and removal of cerebrospinal fluid

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3
Q

How many ventricles are present in the brain

A

4

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4
Q

Which ventricles are the largest and where are they located?

A

Lateral ventricles
One in each cerebral hemisphere

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5
Q

Where is the third ventricle located?

A

Midbrain
Smallest

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6
Q

Where is the 4th ventricle located?

A

Dorsal pons and midbrain

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7
Q

What cells filter the blood entering the ventricular spaces?

A

Ephithelial

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8
Q

How much CSF is produced in adults?

A

Adults generally produce 400-600 ml/day

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9
Q

Describe CSF

A

Clear watery fluid that surrounds brain and spinal cord

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9
Q

What are the functions of CSF?

A

Shock absorber
Nutrient supply
Waste elimination
Intracranial pressure regulation

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10
Q

Describe the ion concentration of CSF

A

Higher concentration of sodium, magnesium, and chloride
Lower concentrations of potassium and calcium

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11
Q

Whos is hydrocephalus most common in?

A

Infants

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12
Q

What is hydrocephalus

A

Build up of fluid in the ventricles of the brain

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13
Q

What causes hydrocephalus?

A

Caused by an imbalance in how much CSF is produced and how much is absorbed in the bloodstream

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14
Q

What are the 4 types of head bleeds?

A

Subdural
Epidural
Intracerebral
Subarachnoid

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15
Q

What are the clinical manifestations of increased ICP?

A

Drop in GCS
Projectile vomiting
Eye edema
Nonreactive pupils

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16
Q

How can we measure ICP?

A

Ventriculostomy
Catheter placed in right ventricle to monitor pressure

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16
Q

What is the cushing reflex?

A

Increase in blood pressure
Decrease in heart rate
Irregular breathing pattern

17
Q

What is a normal ICP?

A

5-15 mmHg

18
Q

What does a normal ICP waveform look like?

A

3 distinct peaks, each decreasing in amplitude

19
Q

What is the purpose of a ventriculostomy?

A

Monitor ICP
Drain excess CSF to reduce pressure

20
Q

Is variation in ICP with each cardiac cycle normal?

A

Yes

21
Q

What do A-waves look like?

A

Shark fin

22
Q

What do A-waves in ICP pressure indicate?

A

Poor compliance within the brain

23
Q

What do B-waves in ICP pressure indicate?

A

Poor compliance within the brain

24
Q

What do B-waves look like?

A

Sharp peaks

25
Q

Which is worse, A-waves or B-waves?

A

A waves, awful

26
Q

Describe cerebral blood flows relationship to MAP

A

CBF is independent from MAP
CBF is kept constant by autoregulation of cerebrovascular resistance

27
Q

How is cerebral autoregulation achieved?

A

vasoconstriction/vasodilation of cerebral blood vessels
Sphincter like mechanisms in the precapillary arteriole

27
Q

When is cerebral blood flow compromised?

A

When MAP is too low
When ICP is too high

28
Q

What is cerebral autoregulation very sensitive to?

A

Changes in PCO2 and pH

29
Q

How is cerebral perfusion pressure measured?

A

CPP=MAP-ICP

30
Q

What is the critical range for CPP?

A

20-40 mmHg

30
Q

What is the normal range for cerebral perfusion pressure?

A

60-100 mmHg

31
Q

What happens to cerebral arterioles when MAP falls below 60?

A

Cerebral arterioles are maximally dilated
Brain is at risk for ischemia

31
Q

What cerebral perfusion pressure should be targeting in ICU patients?

A

70-90 mmHg

32
Q

What happens to cerebral arterioles when MAP is greater than 150 mmHg?

A

Cerebral arterioles are maximally constricted
Any further increase in pressure may cause excess CBF that may result in increased ICP

33
Q

What is the minimum CPP require for adequate brain perfusion?

A

50 mmHg

34
Q

What happens when CPP is less than 30 mmHg?

A

Brain death

35
Q

What happens when CPP is greater than 150 mmHg?

A

Hyperemia
Excess blood in vascular system

36
Q

What does the P1 wave in an ICP pressure wave represent?

A

percussion wave due to arterial pulsation

37
Q

What does the P2 wave represent in an ICP waveform?

A

tidal wave, represents brain compliance

38
Q

What does the P3 wave represent in an ICP waveform?

A

dicrotic wave, represents aortic valve closure

Concepts in Critical care (5 decks)

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