Meds: TBI & Spinal Injury Flashcards
Vasopressors used in neurogenic shock
- Phenylephedrine Hydrochloride
- Dopamine
- Norepinephrine
There is insufficient evidence to support the use of _______ in spinal cord injury
Steroids
Hypovolemia in TBI patient is dangerous. What fluids would you use?
AVOID HYPOTONIC SOLUTIONS & solutions with sugar, rather use HypERtonic solutions -> Lactated Ringers & Normal Saline 3%-23.4%
Monitor sodium levels. Hyponatremia can cause brain swelling
Careful not to fluid overload and cause pulmonary edema
Treat a patient with the elevated ICP Hypotension.
Hypertonic saline : normal saline 3-23.4%
Not a diuretic
Treatment of patient with elevated ICP who is normotensive and euvolemic
Mannitol (Osmitrol)
20% solution (20g in 100ml of solution)
Mannitol (Osmitrol) is contraindicated in what patients? Why?
TBI patient who are Hypotensive &/or Hypovolemic. Because it is a potent osmotic diuretic and can worsen hypotension and cerebral ischemia
Treatment for a euvolemic patient w/ TBI in observation who develops an acute onset of a dilated pupil, has hemiparesis, or loses consciousness? How is it given
Mannitol (Osmitrol)
In this case, give a bolus 1g/kg rapidly over 5 minutes & immediately transfer to CT scanner or operating room if a causative surgical lesion is already identified
Mannitol dosing to control elevated ICP? What should be avoided?
0.25-1g/kg; arterial hypotension (systolic BP < 90 mmHg) should be avoided
When using Manitol for treatment of elevated ICP. What should be used for monitoring? What is a contraindication? Goals of treatment?
ICP Monitor, unless evidence of herniation. Keep Sasm < 320mOsm. maintain euvolemia, and use bolus rather than continuous drip
Sasm (serum osmolality)
What is used to control elevated ICP refractory to maximum standard medical & surgical treatment? What is essential before and during this treatment?
High dose barbituates
Hemodynamic stability
Barbituats should not be used in patients with ____ & ____
Hypovolemia & Hypotension
*can worsen hypotension so they should not be used in the acute resusitve phase
The long ____ of most barbiturates prolongs the time for determining ___, which is a consideration in patients with devestating & likely nonsurvivable injury
Long 1/2 life which will prolong the time for determining brain death
Early use of this class of medications can control acute seizures, however early use does NOT change long-term traumatic seizure outcome
Anticonvulsants
3 main factors linked to high incidence of late elilepsy
- Seizure occurring within the 1st week
- Intracranial hematoma
- Depressed skull fracture
______ can inhibit brain recovery, so they should be used only when absolutely necessary
Anticonvulsants
