Raised ICP

Question 1

Airway

Answer 1

ATLS principles: c spine immobilisation

Question 2

Breathing

Answer 2

Look: increased respiratory effort
Listen: breath sounds
Feel: expansion, tracheal deviation, percussion

RR (changing, Kaussmal breathing)
O2 - Give 15L O2 if required

ABG - lactate for sepsis
CXR: for aspiration risk

Question 3

Circulation

Answer 3

Look: anaemia, diaphoresis
Listen: S1,S2+0
Feel: pulses, CRT central and peripheral

BP: high systolic (wide pulse pressure)
HR: low (bradycardia)

ECG

Bloods: FBC, UEs, LFTs, CRP, group and save, clotting, blood cultures, glucose, toxicology

Management:
1. Fluid resuscitation
2. Exclude sepsis by doing qSOFA

Question 4

Disability

Answer 4

PEARL (pinpoint pupils?)
GCS
BM
Focal neurology signs
Fundoscopy for raised ICP
STAT: CT HEAD or full trauma CT
See drug chart for anticoagulation or opiate -> give 400 micrograms naloxone

Management

GCS: Mild (14-15)
GCS: Moderate (9-13)
GCS: Severe (3-8)
* Immediate intubation & ventilation
* Treat hypotension aggressively

Neuroprotection:
* Ensure head in mid-line position, head tilted to 30 degrees
* Maintain well oxygenated
* Maintain PaCO2 at 4.5
* Maintain CPP >60 (CPP = MAP – ICP)

Raised ICP
* Remove patient from ventilator & initiate manual hyperventilation
* Increase noradreline to increase CPP
* Give mannitol 0.25g/kg over 20 mins

Reversal agents: naloxone

Escalate to neurosurgery + ITU

Question 5

Exposure

Answer 5

calves
abdo exam
temperature
full skeletal survey
head trauma
urinalysis
toxicology