Neurosurgery

Panic Away

Panic Away End Anxiety and Panic Attacks

Get Instant Access

Table 5.1. Treatment of elevated ICP

Conventional measures

1. Elevation of head and relief of potential venous obstruction

2. Elevation of MAP (if appropriate)

3. PaCO2 of 30-35 mmHg, or 25-30 mmHg if there are signs of brain herniation

4. Mannitol 0.5-1.0 g/kg q. 6 h prn and furosemide 20 mg prn. Keep serum osmolality <320.

5. Maintain hypovolemia; monitor CVP, if possible.

6. Ventriculostomy for drainage of CSF, if applicable.

7. Sedation with opiates, benzodiazepines and/or propofol

8. Fine-tune the level of PEEP, if applicable.

9. Maintain normovolemia.

Aggressive measures (in patients refractory to conventional measures)

1. Induction of hypothermia to 33-34°C

2. Maximal EEG suppression with induction of propofol or barbiturate coma

3. Hyperventilation to PaCO2 of 20-25 mmHg (monitor SjvO2 or PbrO2)

4. Hypertonic saline (3% or 7.5% 25-50 ml/h); monitor serum sodium Extreme measures

1. Decompressive craniectomy

2. Excision of infarcted tissues ± lobectomy

This can be accomplished with maintenance of normovolemia and infusion of phenylephrine at 1-10 ^g/kg/min, or norepinephrine at 0.05-0.2 ^g/kg/min.

Was this article helpful?

0 0
Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

Get My Free Ebook


Post a comment