NEUROQBANK

Announcements: Neuromuscular section updated with more questions.

ETIOLOGY:  variety of causes (tumor, malignancy, stroke, encephalitis, hemorrhage, hydrocephalus, trauma, global anoxic brain injury)

 

SIGNS AND SYMPTOMS:  headache, nausea / vomiting, somnolence or coma, hiccups, yawning, focal deficits especially brainstem findings, seizures, anisocoria, unreactive or blown pupil, posturing, abnormal breathing pattern, Cushing’s triad [hypertension, bradycardia and irregular respirations]

 

WORKUP:  ABCs, clinical exam and STAT HEAD CT (wheel the patient yourself)

 

MANAGEMENT (If high suspicion, may want to start treatment on your way to CT)

  • ABCs: vital signs and cardiac monitoring, consider intubation
  • HOB elevated at 30 degrees, head facing forward
  • Consult neurosurgery (370 4492) for possible intervention
  • Goal ICP < 20 mm Hg and cerebral perfusion pressure (CPP) > 60 (see below for equation)

 

If herniation present:

  • STAT mannitol 100 g and then proceed to mannitol protocol (see next page) OR hypertonic saline
  • Hyperventilation: for goal pCO2 ~ 30

 

If ICP due to tumor:

  • dexamethasone 10 mg IV x 1, then 4 mg q6hr

 

For any patient with a mass lesion, stroke, tumor, hemorrhage, keep goal Na 140-145 (may need to go higher depending on what ICP does).  Avoid free water in IVF such as D5W, ½ NS, D5 ½ NS, LR

 

CPP = MAP – ICP

MAP ≈ (2DBP+SBP)/3

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