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TBI (MANAGEMENT (GENERAL (SEIZURE PROPHYLAXIS causes ICP to rise and…

- - - - MANAGE
        
        HYPER OSMOLAR THERAPY
        
        MANNITOL (0.25- 1 g/kg iv) INTERMITTENT BOLUSES Do not let serum osmolarity to exceed 320 mmol/L
        
        HYPERTONIC SALINE
        
        CSF DRAINAGE
        
        VENTILATION THERAPIES
        
        NMBA
        SE: Hypotension, reduced c.o., increased intra pulmonary shunting leading to hypoxia. May cause paradoxical drop in CPP thus negating benefits of reduced ICP
        
        Refractory raised ICP
        
        High dose barbiturates if hemodynamically stable and with injuries compatable with recovery
        Causes a dose dependent decrease in arterial BP and c.o., thus intensive cardiac montioring and BP support
        
        Hyperventilation to paco2 < 30mmHg
        jugular venous oxygentaion and cerebral blood flow to be monitored
        
        Decompressive craniotomy
        
        Repeat CT
        
        Ventricular drainage of CSF
        
        Mild hyperventilation
        
        Decreases arterial CO2, causes cerebral vasoconstriction, reduces CBF, and reduce ICP
        Mismatch of CBF to metabolism. Increased flow lowered by hyperventilation thus reducing blood volume and subsequently ICP
      - MONITOR
        
        INDICATIONS FOR ICP MONITORING
        CT showing signs of severe TBI OR
        Normal CT but with Age >40
        UL or BL motor posturing
        Systolic BP < 90 mmHg
        
        Intra ventricular catheter connected to an external pressure transducer
        
        Gold standard
        Measure global pressure
        Low cost
        In vivo calliberation possible
        Therapeutic CSF drainage and admin of drug
        Benefits far out weigh risks (Infection and hemorrhage)
    - - Vasopressors
        Assure normovolemia with CVP 5-10 mmHg to avoid
        hypervolemia related pulmonary complications
        Alpha agonists like Nor epinephrine
      - PROPOFOL
        Propofol Infusion Syndrome
        Hyperkalemia, Hepatomegaly, Lipemia, Metabolic acidosis, Myocardial failure, Rhabdomyolysis, RF, Death
        Extreme caution when propofol used greater than 5mg/kg.h or when usage exeeds 48 hours
        
        Hypnotic of choice
  - - - Not recommended
        Fits controlled with Diazepam, Phenytoin, Sodium valproate
    - - Not recommended as no improvement in mortality. also a/w side effects- nutritional, metabolic and glycemic status
- - - - Djokovic