Plan

A. Emergency Management. Initiate emergency treatment if patient has signs of increased intracranial pressure (bradycardia and hypertension along with mental status or papillary changes).

1. Increased intracranial pressure is a neurologic emergency. Elevate head of bed 30-45 degrees to improve jugular venous pressure.

2. Hyperventilation should not be used in cases of head trauma; it will rapidly result in cerebral vasoconstriction due to hypocarbia.

3. Give mannitol (an osmotic diuretic), 0.25 g/kg, 20% solution, IV. Maintain serum osmolarity < 320 mOsm.

4. If an intracranial space-occupying lesion is present, neurosurgical intervention is required.

5. Patients with severely increased intracranial pressure require an intracranial pressure monitor, intubation, and mechanical ventilation. General anesthesia may be required; often pento-barbital is used because response can be titrated and followed by continuous bedside EEG monitoring. A loading dose of 15-20 mg/kg IV is given over 1-2 hours; patient is then maintained on continuous IV infusion of 1 mg/kg/h. Infusion is weaned after 1-5 days to assess clinical effectiveness.

B. Seizures. For active convulsive seizures, place patient on his or her side, control airway, and protect from objects that may fall onto or otherwise harm patient during seizure. Antiepileptic medications are indicated if seizures are protracted or recurrent. In epileptic patients, doses may need to be adjusted or new medications prescribed.

C. Concussion. Concussions in children may occur during sports activities and competitions. On-site and follow-up management is outlined below.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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