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14 Cards in this Set
- Front
- Back
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Define intracranial compliance |
Change in volume over change in pressure Initially linear, later exponential |
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CPP optimization - range? |
>60 to avert ischemia <110 to avoid breakthrough hyperperfusion and cerebral edema |
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What are Lundberg waves? |
Lundberg A waves (plateau waves) represent prolonged periods of profoundly high ICP Lundberg B waves are shorter duration, lower amplitude elevations that indicate compliance reserves are compromised |
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Cushing triad |
Hypertension Bradycardia Elevated ICP |
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Hallmark of uncal herniation |
CN III palsy Contralateral/ bilateral motor posturing |
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Hallmark of transtentorial herniation |
Progression from bilateral decorticating to decerebrate posturing
Rostral - caudal loss of brainstem reflexes |
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Hallmark of subfalcine herniation |
Asymmetric motor posturing (contralateral > ipsilateral)
Preserved oculocephaluc reflex |
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Hallmark of cerebellar herniation |
Cerebellar signs
Sudden progression to coma with bilateral motor posturing |
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Hallmark of cerebellar herniation |
Cerebellar signs
Sudden progression to coma with bilateral motor posturing |
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Preferred regimen for adequate sedation |
Fentanyl 1-3 ug/kg/h Remifentanil 0.03 to 0.25 ug/kg/min |
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Precaution in using opioids for analgesia in ICP crises |
May elevate ICP - transiently lower MAP and increase ICP by autoregulatory vasodilation of cerebral vessels |
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2 mechanisms mannitol works |
As osmotic diuretic, creates conc gradient across BBB and extracts water from brain
Increases CPP through plasma explanation and promotes vasoconstriction and CBV reduction by decreasing blood viscosity and improving CBF |
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How to give pentobarbital (dosing) |
Repeated 5-mg/Kg blouses q15-30mins until ICP controlled (usually requires 10-20 mg/Kg)
Then continuous infusion at 1-4 mgkg/hr |
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Most common complication of pentobarbital therapy |
Hypotension from cardiac suppression |
