Principle of Cerebral Resuscitation PDF

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principle of management TBI...

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Principle of Cerebral Resuscitation

Intervention that occur after hypoxic or ischemic events. Primary goals are : 1) To minimize cerebral edema 2) To minimize intracranial pressure 3) To optimize cerebral perfusion pressure

Brain Injury Resuscitation •

Maintain normal body temperature and prevent and treat hypothermia.

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Avoid systemic hypotension

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Avoid steroid administration

Fluid resuscitation •

Institute isovolaemic dehydration with hypertonic saline solution ( HSS , .5% or 3% NaCl) and mannitol

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Consider resuscitation hypotensive patients with 4mL/kg 7.5% HSS

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The patient’s head of bed should be elevated at 30 degree all the times.

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Maintain normocarbia

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Maintain cerebral perfusion pressure within range of 50-70mmHg

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Give adequate sedation using short-acting agents such as propofol

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When ICP >20 mmhg, maintain PaCo2 between 30 and 35 torr.

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Consider phenobarbital coma for intractable intracranial hypertension ICP>20mmHg

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Decompressive craniectomy should be considered in patients below 18 years old with intractable intracranial pressure and not response to medical manaement

Indication of ICP monitoring •

Glasgow coma score < 8 after resuscitation

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Abnormal CT scan of head

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Age > 40years

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Unilateral or bilateral motor posturing

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Systemic hypotension

References : •

Clinical Practice Guidelines on Initial Management of Head Injury in Adult...