Table 21.8. Management of severe head injury in the ICU.
Stepwise progression of therapy intensity level in management of patients with severe head trauma
ATLS protocol, intubation, ventilation, oxygenation and hemodynamic resuscitation.
Sedate the patient with (morphine, propofol); avoid long-term muscle relaxants.
Keep the patients head up 35°.
Ventilate to a PCO2 of 30-33 mmHg.
Insert ICP monitoring device; keep the ICP at <20 mmHg.
Keep the perfusion pressure at 60-70 mmHg .
If needed, administer mannitol or hypertonic saline to maintain an osmolality at 310-320. Load the patient with phenytoin and continue this medication for about 1 week. Start nutrition within 72 hours.
vent settings kept his PCO2 at around 30-33 mmHg, in addition to osmotherapy with mannitol. His EVD was continued for 12 days until the ICPs were stable and then the IVC was removed. The graph in Fig. 21.2 indicates his therapy intensity level within the first 25 hours of admission.
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