Page 156 - Critical Care Notes

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NEURO

Complicating Factors
■ Skull fracture, scalp lacerations
■ Cerebral contusion, concussion
■ Subarachnoid hemorrhage (SAH)
■ Subdural, extradural, epidural hematoma
■ Cerebral edema
■ ↑ ICP, ↓ cerebral perfusion, cerebral ischemia
■ Seizures
■ Impaired oxygenation/ventilation → respiratory depression and failure
■ Infection
■ Herniation, coma, persistent vegetative state, or death
Diagnostic Tests
■ Check for CSF leak
■ X-ray, CT of the head, MRI, or PET to assess hematoma, swelling, and
injury
■ TCD ultrasound
■ EEG
■ Cerebral angiography or CTA
■ CBC, chemistry panel, and blood coagulation studies
■ Global cerebral oxygenation as measured by jugular venous bulb oximetry
(SjO 2 ). Measures mixed venous O 2 saturation of blood leaving the brain:
50%–75% normal; <50% indicates an ↑ rate O 2 extraction from cerebral
ischemia.
■ Urinalysis for specific gravity
Management
■ Management is similar to that for increased ICP.
■ Stabilize cardiac and respiratory function to ensure adequate cerebral per-
fusion. Maintain optimum ABGs or O 2 saturation. Assess oxygenation and
respiratory status. Mechanical ventilation may be needed.
■ Assess and monitor neurological status and ICP; calculate CPP to maintain
>70 mm Hg.
■ Perform frequent neurological checks, including Glasgow Coma Scale.
■ Provide light sedation as necessary to ↓ agitation. Administer analgesics for
pain. Induce barbiturate coma if necessary.
■ Administer hypertonic saline and osmotic diuretics (Mannitol) as needed.
■ Institute ICP monitoring and control for elevations in ICP.
■ Induce therapeutic hypothermia.
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