1
Q
Herniation
A
Temporal/Uncal - cranial nerve 3 palsy (unopposed sympathetics = pupillary dilation) + also get contra lateral hemiparesis
2
Q
ICP
A
> 22 = poor outcomes and refractory to treatment
10 is normal
Monro-Kellie Doctrine
Venous blood and CSF compressed as buffer for rising ICP - but eventually cannot compensate —> herniation
CPP = MAP - ICP
3
Q
CT scan indications
A
Brain injury, skull fracture, two episodes of vomiting, or >65 years
4
Q
Medical therapies
A
IV fluids Anticoagulation correction - warfarin - FFP, prothrombin, factors - heparin - protea mine soulmate - Dabi - Praxbind - DOACs - prothrombin concentrate Hyperventilation - cerebral vasoconstriction, hypercarbia increases intracranial pressure Mannitol - don’t give in hypotension Hypertonic saline Barbiturates - refractory ICP Anticonvulsants - only when necessary - Intracranial haematology, depressed skull fracture or seizure Antibiotics maybe if penetrating injury
5
Q
Brain death
A
Non reactive pupils
Absent reflexes
No spontaneous effort
Absence of confounding factors
Ancillary measures
EEG
CBF
Cerebral angiography
