Brain Resuscitation (R4): Drug Interventions PDF

\*\*Intracranial Pressure (ICP) Management\*\* \*\*Q1:\*\* What are the initial pharmacological interventions for managing elevated ICP, and what are the fentanyl dosing guidelines? \*\*A1:\*\* Titrated fentanyl (25--50 mcg IV every 5 minutes) for analgesia. Propofol is preferred for sedation to r...

\*\*Intracranial Pressure (ICP) Management\*\* \*\*Q1:\*\* What are the initial pharmacological interventions for managing elevated ICP, and what are the fentanyl dosing guidelines? \*\*A1:\*\* Titrated fentanyl (25--50 mcg IV every 5 minutes) for analgesia. Propofol is preferred for sedation to reduce cerebral metabolic demand. Dexmedetomidine is an alternative but may cause hypotension/bradycardia. \*\*Q2:\*\* What are the dosing protocols for barbiturate-induced coma in refractory intracranial hypertension? \*\*A2:\*\* Pentobarbital: 10 mg/kg IV loading dose over 30 minutes, followed by 1--4 mg/kg/h infusion. Monitor for hypotension requiring vasopressors. \*\*Q3:\*\* Compare osmolar therapy options for acute ICP spikes. Include doses and administration routes. \*\*A3:\*\* \- \*\*Mannitol\*\*: 0.25--1 g/kg IV every 6h (max serum osmolality 320 mOsm/kg). Preferred in fluid overload. \- \*\*23.4% hypertonic saline\*\*: 30 mL IV every 6h (max serum sodium 160 mEq/L). Use a central line. \- \*\*3% hypertonic saline\*\*: 30--50 mL/hr continuous infusion. \*\*Q4:\*\* What are key side effects of propofol and dexmedetomidine in ICP management? \*\*A4:\*\* Propofol: Hypotension (dose-dependent). Dexmedetomidine: Hypotension, bradycardia, ventilator dyssynchrony (no respiratory drive suppression). \-\-- \*\*Seizure Management\*\* \*\*Q5:\*\* What is the first-line treatment for acute seizures, and what is the maximum lorazepam dose? \*\*A5:\*\* Lorazepam 0.1 mg/kg IV (max 4 mg). Follow with second-line antiepileptics. \*\*Q6:\*\* List second-line antiepileptic options with dosing for status epilepticus. \*\*A6:\*\* \- \*\*Fosphenytoin\*\*: 20 mg PE/kg IV (max 1500 mg PE). \- \*\*Levetiracetam\*\*: 60 mg/kg IV (max 4500 mg). \- \*\*Valproic acid\*\*: 40 mg/kg IV (max 3000 mg). \*\*Q7:\*\* When is prophylactic levetiracetam used in TBI, and what is the dosing regimen? \*\*A7:\*\* To reduce early seizures (first 7 days). Dose: 500 mg bid for 7 days (adjust for renal function). Avoid phenytoin due to neurocognitive risks. \*\*Q8:\*\* In which conditions is prophylactic anticonvulsant use contraindicated? \*\*A8:\*\* Intracerebral hemorrhage (ICH) and post-cardiac arrest (no proven benefit, worse outcomes). \-\-- \*\*CPR & Perfusion Optimization\*\* \*\*Q9:\*\* What blood pressure targets are recommended post-cardiac arrest and in ICH? \*\*A9:\*\* \- \*\*Post-cardiac arrest\*\*: MAP \>65 mm Hg, SBP \>90 mm Hg. \- \*\*ICH\*\*: Target SBP \