IICP Management in Traumatic Brain Injuries

🖥️ Watch teaching video

---

Management of Intracranial Hypertension (IICP) in Traumatic Brain Injuries:

1. Check Blood Glucose. 

• Hypoglycemia can mimic neurologic disasters and can be the cause trauma.
• If rapid glucose test not possible, empirically treat with 50 cc of 50% dextrose.

2. Check Pupils. 

• Unilateral pupillary dilatation is a cardinal sign of uncal herniation.
• Central herniation causes pinpoint pupils.
• Tonsillar herniation causes mid-fixed pupils.

3. Prevent Hypoxia and Hypotension.

• Secure airway and start oxygen early.
• There is no role for permissive hypotension; keep mean arterial pressure above 80 millimeters mercury.
• Resuscitate before you intubate to avoid peri-intubation hypoxia and hypotension.

4. Reduce ICP Prior to Imaging.

• Raise the head of the bed to 30 degrees.

• Mannitol 50 g bolus, 3% hypertonic saline 250 cc bolus, or 8.4% sodium bicarbonate 80-120 cc bolus.