Optic Nerve Sheath Ultrasound for Detecting Increased Intracranial Pressure (ICP)

In podcast 78 on the management of elevated ICP, I discussed ocular nerve sheath ultrasound. Here are some additional resources.

Key Aspects of the Technique

  • Must see lens or iris in the scan or you are scanning nerve off-axis. If off-axis, may underestimate OSND diameter.
  • Measure Outside Diameter (OD)

Literature

  • Crit Care 2008;12:150
  • Acad Emeg Med 2003, Vol. 10, No. 4
  • Tayal VS Ann Emerg Med 2006
  • Emerg Med J 2007;24:251
  • Annals of Emergency Medicine 2007;49(4):508-514
  • Inten Care Med 2007;33:1704
  • Academic Emergency Medicine 2008;15 (2) , 201-204
  • Inten Care Med 2008;34:2062
  • Neurocritical Care Dec 2009
  • emerg med j 2011;28:679
  • J Trauma 2011;71:779)
  • Neurocrit Care 2011;15:506
  • Review Article (Acta Anaesthesiol Scand 2011;55:644)

Blogposts

From Life in the Fast Lane

 

Media

From Ultrasound Podcast guys, a 1-minute tutorial

Link to Full Ultrasound Podcast on Ocular Nerve Sheath Exam

 

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Comments

  1. Hi, I’m wondering why the ETCO2 may not match the PaCO2 in a head injury patient (who is not in shock or has any underlying cardiovascular disease). Thanks!

    • If they had none of those things, and no atelectasis, and no other trauma it would probably correlate fairly well–at first. Most TBI patients are not that isolated. One correlated set- of-samples doesn’t tell you that their lungs have not started to get bad later on. The TBI state leads to ALI and ARDS on its own without any coexisting external lung injury.

  2. Don Diakow says:

    This just wants me to have a Pocket ultrasound machine when I’m on calls. Besides that this is excellent stuff thanks Ultrasound guys!

  3. I used this technique just last week to confirm an elevated ICP reading by a Codman. I didn’t have a Tegaderm handy, so I just cut a latex glove into sort of a square sheet which I draped over the patient’s closed eye, and then applied ultrasound gel over the latex, leaving the eye completely residue free. Perfect images. Great podcast!

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