Medical Management of TBI Flashcards
what class of medications can be used to induce coma and decrease metabolic requirements of brain
barbiturates or propofol
when ICP reaches _______, there is neurogical dysfunction and brain impairment
> 40 mmHg
what may anisocoria indicate?
transtentorial herniation to ipsilateral side
MOA of Benzos
GABA
Central perfusion pressure (CPP) should be kept at
> 60 mmHg
what class of medications can be used to control anxiety and agitation
Benzos - cannot be used long term
whats more important, controlling CPP or the ICP?
CPP
what cranial nerve does uncal herniation affect
CN 3
Anisocoria
inequality in pupil size
elevated ICP is defined as
> 20 mmHg for more than 5 minutes
CT findings that indicate increased ICP
absence of third ventricle and CSF cisterns
How do you calculate CPP?
MAP - ICP
in a normal adult, normal ICP is between
2 and 5 mmHg
At what GCS is endotracheal intubation indicated
GCS less than or equal to 8
uncal herniation can produce ipsilateral or contralateral hemiparesis if what or what is affected?
if corticospinal tract is affected, you get ipsilateral hemiparesis. if precentral motor cortex is affected, you get contralateral hemiparesis
PO2 should be kept between
100 and 120 mmHg
when ICP reaches ________, it’s usually fatal
> 60 mmHg
why cant you give steroids for increased ICP management
increased in 2-week mortality in those given steroids in the acute phase
PCO2 should be kept between
28 and 32 mmHg
At what GCS is a CT head indicated
GCS <13
most rapid means of lowering ICP
hyperventilation to reduce PaCO2
what are some things you can do to decrease ICP?
raise head of bed, mannitol, hyperventilate
Intracranial Pressure (ICP) should be kept at
<20 mmHg
correlation between CPP and ICP
When ICP goes up, CPP goes down (MAP - ICP)
what physical exam finding can be used to monitor ICP
papilledema
