Traumatic Head Injury and Intra-Cranial Pressure Management

Question 1

-tomy vs -ectomy

Answer 1

-tomy = to cut into

-ectomy = to take out

Question 2

What is an ostomy

Answer 2

to connect something inside to the outside world

Question 3

What is a global defecit and how can we score it?

Answer 3

Affects the whole brain. Can be measured though GCS

Question 4

Where do you put in a icp ?

Answer 4

frontal lobe right side hair line

Question 5

What is a normal ICP

Answer 5

5-15mmHg or 10-20 cmH20

Question 6

P1 P2 and P3

Answer 6

P1 = Systolic pressure
P2 = tidal (bounce back)
P3 = aortic closure

Question 7

What is cushings response?

Answer 7

Signs of increased intracranial pressure.
widened pulse pressure, bradycardia and irregular respirations.

ICP>MAP therefore not enough perfusion in brain. Sympathetic system is activated, increasing blood pressure, in turn activating baro receptors (aortic and carotid) -> parasymp activation and reduced heart rate. Late stage measn the brain stem is involved and leads to abnormal breathing.

Question 8

When would you use Manitol (osmotherpy)

Answer 8

ONLY if the patient with increased ICP is going to be treated wihtin the next 20 minutes or so.

Question 9

What are the differences of Mannitol and hypertonic saline (both treatment for raised ICP)?

Answer 9

Mannitol -> causes hypovolaemia, v easy to give and leads to excessive dehydration

Hypertonic saline, needs titrating but less side effects (aims to increase osmolarity by adding sodium)

Question 10

What is the treatment of ICP

Answer 10

*SIT UP
*take off neck collar
*Normal PaCO2 and PaO2
*maintain normal bp and glucose