Raised ICP

Question 1

List 5 methods for managing raised ICP in the ED.

Answer 1

1. Elevate head of bed to 30degrees
2. Optimise conditions for venous drainage - neck-ties, neutral head position
3. Hyperventilation -> acutely decreases ICP at expense of perfusion
4. Hypertonic saline - 5ml/kg 7.5% normal saline IV/IO over 10mins
5. Mannitol - osmotic diuresis - 1g/kg

NB: Whilst glucocorticoids may be of benefit in reducing ICP in brain lesions and infections, they are not indicated in trauma as they worsen outcome.