5.1 J) Xi) Surgical Trauma Management Of Symptomatic Increased Intracranial Pressure

Front 1

(Dunn)

What are the main categories / Facets of

managing the acute increase in intracranial

pressure (ICP) in traumatic head injury?

Back 1

Neuroprotective Strategy

1. Posture head of bed to 30 degrees
2. Airway hyperventilation
3. Hyperosmolar therapy
4. Surgical intervention

Front 2

(Dunn)
Which of the following is incorrect regarding acute interventions for increased intracranial pressure?
A. Hyperventilation reduces intracranial pressure by reducing CBF.
B. The PCO2 should be maintained around 35 mmHg when

hyperventilating.
C. Hyperventilation reduces ICP after 5-10 minutes, lasting up to 2 hours.
D. Hyperoxia must be avoided, aiming for a PO2 of 100mHg.

Back 2

C. onset within minutes-lasting up to 1 hour.

Front 3

(Dunn)
Which of the following is correct regarding

Interventions for traumatic-induced increased intracranial pressure?
A. Elevating the head of the bed to 30 degrees reduces arterial inflow to the brain.
B. The target mean arterial blood pressure should be > 65 mmHg
C. Ideally, the patient should be euvolaemic.
D. Hyperosmolar agents exert their effect by removing water from the oedema of the mass lesion.

Back 3

C.

A = aids venous drainage
B= MAP > 80 mmHg
D = removes water from "normal" brain tissue.

Front 4

(Dunn)
Which is incorrect regarding Secondary brain

injury from trauma?
A. A common ECG finding is a Junctional rhythm
B. Steroids are ineffective in trauma-related cerebral oedema
C. The target serum osmolarity for hyperosmolar therapy is 300-320 mOsm/L
D. Cerebral oedema usually has more severe sequelae in Children compared with the elderly / young adults.

Back 4

D. Usually more sequelae in young adults compared with elderly / Children due to :
- increased brain : skull volume ratio

Front 5

List 6 techniques in the prevention of secondary brain injury from trauma.

Back 5

1. Posture elevate head of bed 30 degrees

2. Airway interventions

3. Fluid balance

4. Hyperosmolar therapy

5. Seizure prophylaxis

6. Surgical intervention

Front 6

What 2 main ventilatory interventions

exist post intubation for preventing secondary brain injury in trauma?

Back 6

1. Hyperventilate - aim PCO2 30-35

2. Oxygenate to PO2 100mmHg

Front 7

What core fluid balance / haemodynamic

interventions / parameters exist fro preventing

secondary brain injury in trauma ?

Back 7

1. Maintain euvolaemia

2. Target MAP aim > 80 mmHg

Front 8

What are the 2 main hyperosmolar therapy

options for managing prevention of secondary brain injury in trauma?

Back 8

1. Mannitol 20% 0.5-1.0 G/kg over 30 minutes

[ induces osmotic diuresis ]

2. 3% NaCl 100mL over 30 minutes

[ induces direct increase in serum osmolarity ]

Front 9

What 2 main Neurosurgical Interventions exist for the management of preventing secondary brain injury post trauma ?

Back 9

1. Haematoma drainage

2. Decompression of secondary hydrocephalus

[ EVD - extraventricular drain insertion]