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Management of Intracranial Hypertension in Traumatic Brain Injury

Management of Intracranial Hypertension in Traumatic Brain Injury. Kiran Hebbar, MD 5/31/05. Introduction: Head Injury. Adolescents Boys>>Girls Leading cause of trauma death Primary & Secondary Injury. Key Concepts. Monroe-Kellie Doctrine CPP=MAP-ICP Cerebral Blood Flow.

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Management of Intracranial Hypertension in Traumatic Brain Injury

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  1. Management of Intracranial Hypertension in Traumatic Brain Injury Kiran Hebbar, MD 5/31/05

  2. Introduction:Head Injury • Adolescents • Boys>>Girls • Leading cause of trauma death • Primary & Secondary Injury

  3. Key Concepts • Monroe-Kellie Doctrine • CPP=MAP-ICP • Cerebral Blood Flow

  4. Monroe-Kellie • Skull is a fixed, rigid structure • Total Volume • Brain • Blood • CSF

  5. Monroe Kellie Brain+ Blood+ CSF Skull= Brain+ Blood+ CSF

  6. Goals • Maintain Cerebral Perfusion Pressure • >60 mm Hg • Control Cerebral Blood Flow

  7. CPP= MAP-ICP • CPP- Keep >60 • MAP • Hypertensive therapy • ICP • Skull= Brain+ Blood+ CSF

  8. Cerebral Blood Flow • Blood Pressure • PaCO2 • PaO2 • Skull= Brain+ Blood+ CSF

  9. Cerebral Perfusion • Skull= Brain+ Blood+ CSF

  10. Carbon Dioxide Skull= Brain+ Blood+ CSF

  11. Oxygen Skull= Brain+ Blood+ CSF

  12. Quick Review • Importance of Perfusion • Controlling Blood flow • So what can we do?

  13. Management Strategies • Blood • General • Head Position • Midline • 30 degrees • Temperature Skull= Brain+ Blood+ CSF

  14. Hyperventilation • Blood continued • Decrease CO2 • Vasoconstriction • Decrease blood volume • Skull= Brain+ Blood+ CSF

  15. Sedation • Blood continued • Sedative + Analagesic • Pentobarbital Coma • Burst suppression • Skull= Brain+ Blood+ CSF

  16. Management Strategies • Blood continued • Surgical- Evacuate Bleed/Clot Skull= Brain+ Blood+ CSF

  17. CSF Balance in production and absorption disturbed! Skull= Brain+ Blood+ CSF

  18. Management • Cerebrospinal Fluid • Surgical • External Ventricular Drain (EVD) • Medical • Acetazolimide • Lasix Skull= Brain+ Blood+ CSF

  19. Management Strategies • Brain • Surgical- Resection • Osmotic Agents • Mannitol • 3% NaCl Skull= Brain+ Blood+ CSF

  20. Management Strategies • Brain continued • Hemicraniectomy

  21. Management Summary • 1. Head Position • 2. Hyperventilate (intubate) • 3. Osmotic Therapy • 4.Sedation/Paralysis • 5. Temperature • 6. Hypertensive Therapy • 7. Surgical- EVD/pressure monitor

  22. Thank You! Make time to Decompress!!!!

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