What is the primary concern of the comatose child?
airway management
Respiratory Management in the Comatose Child:
What will cause irreversible brain damage?
cerebral hypoxia lasting >4 minutes
Respiratory Management in the Comatose Child:
What does CO2 retention cause?
vasodilation
increased cerebral blood flow
increased ICP
Respiratory Management in the Comatose Child:
What reflexes may be minimal?
gag and cough reflexes minimal
-leading to risk of aspiration of secretions being increased
What are the 4 indications for ICP monitoring?
- glasgow coma scale score less than 8
- TBI with abnormal CT scan
- deteriorating neurologic condition
- subjective judgment regarding clinical appearance and response
What are the 4 types of ICP monitors?
- intraventricular catheter
- subarachnoid bolt (richmond screw)
- epidural sensor
- anterior fontanel pressure monitor
What do we need to keep in mind when positioning a pt with increased ICP?
- avoid neck vain compression
- provide alternating pressure mattress
- elevate HOB 30 degrees
What environmental factors do we need to consider for a pt with ICP?
- avoid activities that may increase ICP
- eliminate environmental noise
- only use suction to clear the airway
What is neural tube deficit (NTD)?
- failed closure of neural tube around 4th week gestation
- may involve the entire length of the neural tube or a small portion
