Today we are going to discuss increased intracranial pressure (ICP) and herniation. This is the first of 13 lectures to go with the upcoming Emergency Neurological Life Support Course that I co-chair.
Screen for Increased Intracranial Pressure
Head of Bed Up
PaCO2 35-38 mm Hg
Control Pain/Sedate if Intubated
Hypertonic Saline or
Sodium Bicarb (make sure to control PaCO2)
Propofol (or Phenobarb) Drip titrated to take patient to low levels of sedation scales (5-200 mcg/kg/min)
Moderate Hyperventialtion (I reserve for patients who are herniating)
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