ICP

Neurological Complications and Management in Critical Care

• Causes of neurological complications include brain abscess, tumors, head injuries, brain surgery, vascular insults, toxic or metabolic conditions, and cerebral infections
• Symptoms and signs of neurological complications include changes in level of consciousness, vital sign abnormalities, ocular signs, motor function deficits, and other related symptoms
• Complications of neurological conditions include ischemia, herniation, and syndrome of inappropriate antidiuretic hormone (SIADH)
• Glasgow Coma Scale is used to assess the arousal aspect of consciousness, with scores indicating the severity of neurological impairment
• Diagnostic methods for neurological complications include history and physical examination, imaging studies, electroencephalogram, and laboratory tests
• Monitoring methods for intracranial pressure (ICP) include ventriculostomy, fibreoptic catheter, and subarachnoid bolt or screw
• CSF drainage through intraventricular catheter can be used to control ICP and assess cerebrospinal fluid
• Cerebral oxygenation monitoring is crucial for assessing brain tissue oxygenation and guiding management
• Collaborative management goals include identifying and treating the cause, supporting brain function, and preventing complications
• Vital sign considerations in neurological complications management involve inducing hypertension, monitoring oxygen delivery determinants, calculating and monitoring cerebral perfusion pressure, and maintaining normothermia.

Management of Acute Intracranial Problems

• Patent airway is critical to prevent airway obstruction and ensure adequate oxygenation to support brain function.
• Monitoring ABGs is crucial, with a goal of PaO2 ≥ 100mmHg and keeping O2 saturation at 100%.
• Drug therapy options include Mannitol, Hypertonic Saline, High-dose Barbiturates, Corticosteroids, and Anti-seizure drugs, each with specific monitoring and precautions.
• Body positioning to decrease ICP involves maintaining the head of bed at 30°, aligning the head to midline, and minimizing stimuli in the patient's environment.
• Protective measures include a least-restraint approach, seizure precautions, and assessing restrained extremities for circulation.
• Fluid and electrolyte balance should be closely monitored, with attention to signs of SIADH.
• Nutrition therapy is essential for patients with increased ICP, with options including enteral or TPN if oral intake is not possible.
• Secondary injury is a primary concern in managing brain injury, occurring several hours to days after the initial injury.
• Traumatic brain injury (TBI) is a leading cause of death and disability after trauma, with motor vehicle accidents and falls being common causes.
• Factors associated with a poor outcome in head trauma include age, Glasgow Coma Scale scores, and intracranial pressure levels.
• Deaths from head trauma can occur immediately after the injury, within 2 hours, or approximately 3 weeks after injury, with different causes and prevention strategies for each period.
• Assessment and management of specific complications like epidural and subdural hematomas are critical in the care of patients with acute intracranial problems.