management of intracranial hypertension in traumatic brain injury management of intracranial...
TRANSCRIPT
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Management of Management of Intracranial Intracranial
Hypertension in Hypertension in Traumatic Brain InjuryTraumatic Brain Injury
Management of Management of Intracranial Intracranial
Hypertension in Hypertension in Traumatic Brain InjuryTraumatic Brain Injury
Kiran Hebbar, MDKiran Hebbar, MD5/31/055/31/05
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Introduction:Head Injury
• Adolescents• Boys>>Girls• Leading cause of
trauma death
• Primary & Secondary Injury
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Key Concepts• Monroe-Kellie
Doctrine
• CPP=MAP-ICP
• Cerebral Blood Flow
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Monroe-Kellie• Skull is a fixed, rigid structure• Total Volume
– Brain– Blood– CSF
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Monroe Kellie
Skull= Brain+ Blood+ CSF
Brain+ Blood+ CSF
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Goals• Maintain Cerebral Perfusion Pressure
– >60 mm Hg
• Control Cerebral Blood Flow
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CPP= MAP-ICP• CPP- Keep >60
• MAP– Hypertensive therapy
• ICP
• Skull= Brain+ Blood+ CSF
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Cerebral Blood Flow• Blood Pressure
• PaCO2
• PaO2
• Skull= Brain+ Blood+ CSF
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Cerebral Perfusion
• Skull= Brain+ Blood+ CSF
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Carbon Dioxide
Skull= Brain+ Blood+ CSF
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Oxygen
Skull= Brain+ Blood+ CSF
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Quick Review• Importance of Perfusion
• Controlling Blood flow
• So what can we do?
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Management Strategies
• Blood– General
• Head Position– Midline
– 30 degrees
• Temperature
Skull= Brain+ Blood+ CSF
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Hyperventilation• Blood continued• Decrease CO2
– Vasoconstriction
• Decrease blood volume
• Skull= Brain+ Blood+ CSF
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Sedation• Blood continued• Sedative + Analagesic
• Pentobarbital Coma
– Burst suppression
• Skull= Brain+ Blood+ CSF
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Management Strategies
• Blood continued
– Surgical- Evacuate Bleed/Clot
Skull= Brain+ Blood+ CSF
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CSF
Balance in production and absorption disturbed!
Skull= Brain+ Blood+ CSF
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Management• Cerebrospinal Fluid
– Surgical• External Ventricular
Drain (EVD)
– Medical• Acetazolimide• Lasix
Skull= Brain+ Blood+ CSF
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Management Strategies
• Brain
– Surgical- Resection
– Osmotic Agents•Mannitol•3% NaCl
Skull= Brain+ Blood+ CSF
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Management Strategies
• Brain continued
• Hemicraniectomy
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Management Summary • 1. Head Position• 2. Hyperventilate (intubate)• 3. Osmotic Therapy• 4.Sedation/Paralysis• 5. Temperature• 6. Hypertensive Therapy• 7. Surgical- EVD/pressure monitor
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Thank You! Make time to
Decompress!!!!