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Management of Intracranial Hypertension in Traumatic Brain Injury - PowerPoint PPT Presentation


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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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Presentation Transcript
introduction head injury
Introduction:Head Injury
  • Adolescents
  • Boys>>Girls
  • Leading cause of trauma death
  • Primary & Secondary Injury
key concepts
Key Concepts
  • Monroe-Kellie Doctrine
  • CPP=MAP-ICP
  • Cerebral Blood Flow
monroe kellie
Monroe-Kellie
  • Skull is a fixed, rigid structure
  • Total Volume
    • Brain
    • Blood
    • CSF
monroe kellie1
Monroe Kellie

Brain+ Blood+ CSF

Skull= Brain+ Blood+ CSF

goals
Goals
  • Maintain Cerebral Perfusion Pressure
    • >60 mm Hg
  • Control Cerebral Blood Flow
cpp map icp
CPP= MAP-ICP
  • CPP- Keep >60
  • MAP
    • Hypertensive therapy
  • ICP
  • Skull= Brain+ Blood+ CSF
cerebral blood flow
Cerebral Blood Flow
  • Blood Pressure
  • PaCO2
  • PaO2
  • Skull= Brain+ Blood+ CSF
cerebral perfusion
Cerebral Perfusion
  • Skull= Brain+ Blood+ CSF
carbon dioxide
Carbon Dioxide

Skull= Brain+ Blood+ CSF

oxygen
Oxygen

Skull= Brain+ Blood+ CSF

quick review
Quick Review
  • Importance of Perfusion
  • Controlling Blood flow
  • So what can we do?
management strategies
Management Strategies
  • Blood
    • General
      • Head Position
        • Midline
        • 30 degrees
      • Temperature

Skull= Brain+ Blood+ CSF

hyperventilation
Hyperventilation
  • Blood continued
  • Decrease CO2
    • Vasoconstriction
      • Decrease blood volume
  • Skull= Brain+ Blood+ CSF
sedation
Sedation
  • Blood continued
  • Sedative + Analagesic
  • Pentobarbital Coma
    • Burst suppression
  • Skull= Brain+ Blood+ CSF
management strategies1
Management Strategies
  • Blood continued
    • Surgical- Evacuate Bleed/Clot

Skull= Brain+ Blood+ CSF

slide17
CSF

Balance in production and

absorption disturbed!

Skull= Brain+ Blood+ CSF

management
Management
  • Cerebrospinal Fluid
    • Surgical
      • External Ventricular Drain (EVD)
    • Medical
      • Acetazolimide
      • Lasix

Skull= Brain+ Blood+ CSF

management strategies2
Management Strategies
  • Brain
    • Surgical- Resection
    • Osmotic Agents
      • Mannitol
      • 3% NaCl

Skull= Brain+ Blood+ CSF

management strategies3
Management Strategies
  • Brain continued
  • Hemicraniectomy
management summary
Management Summary
  • 1. Head Position
  • 2. Hyperventilate (intubate)
  • 3. Osmotic Therapy
  • 4.Sedation/Paralysis
  • 5. Temperature
  • 6. Hypertensive Therapy
  • 7. Surgical- EVD/pressure monitor