Increased ICP Flashcards
What is ICP
The amount of pressure that blood, brain, and CSF exert on the skull
What is the normal ICP range
5-15mmhg
Causes of increased ICP
Space occupying lesions; bleed, tumor etc
Cerebral edema; trauma, stroke, ischemia
Metabolic disorders; uremia, hepatic encephalopathy
Increased CSF production from tumor
Decreased CSF drainage; lesion, Chiari
Increased venous pressure; clot, stenosis, HF
Idiopathic intracranial hypertension
What opthalmic findings suggest increased ICP
Fixed dilated pupils
Papiledema
What neuroimaging is suggested for increased ICP
CT: edema, loss of sulci, loss of white/grey matter, enlarged ventricles
MRI: enlarged ventricles, herniation, mass effect, tumors
When should an LP be considered in r/o increased ICP
If neuro imaging is negative
What unit should a patient with increased ICP be admitted to
ICU
What are three devices that can measure ICP
Fiber optic catheter: inserted into brain parenchyma
EVD: connects directly into the ventricles
Optic nerve sheath diameter: measures pressure behind optic nerve
What is CPP and what level should it be maintained at
CPP= MAP - ICP
~60-7pm HMG
What vent changes can be made to decrease ICP transiently
Hyperventilation
Pharmacological therapy for increased ICP
Mannitol: creates osmotic gradient
Steroids: if there is a tumor present
3% hypertonic saline
Acetazolamide: decreases CSF production
Glyburide
Barbituates
What risk do you run providing an LP to decrease ICP
Rapid decrease in CSF with reflex increase in ICP producing herniation
Surgical options for increased ICP
Shunt
Optic fenestrations
Crainiotomy
How is Cushing’s connected to increased ICP
Reflex to produce better blood flow to brain
Late stage of increased ICP
Imminent herniation
What are the s/s of Cushing’s triad
Widened pulse pressure, bradycardia, irregular respirations
