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What are some of the ABX that go in the shunt?
No dextrose
No beta-lactams
Gentamycin = more seizures than any other
aminoglycoside. ampicillin / penicillin intraventricular =
seizures
,What is the monro-Kellie doctrine?
Cerebral blood volume (10%)
+
CSF(10%)
+
Brain tissue(80%)
=== ICP===(med given for ICP targets >one of the above)
What is one major side effect of using Hypertonic
Saline? How do we fix this?
Metabolic acidosis after several hypertonic saline doses
because hyperchloremia.
Combo of sodium chloride and sodium acetate to maintain
the hyperosmolarity of the solution but reduce chloride
(NaBicarb also used but rarely)
,Why is ICP so important to get under control?
Elevated ICP decreases tissue perfusion and tissue oxygenation
and worsens neurological outcome.
At what mmHg to we start treating ICP?
treat sustained ICP greater than 22 mm Hg
What is the ideal CPP?
CPP ideally within 50-70 mm Hg
(rarely patients who have refractory elevations in ICP or who
have a history of uncontrolled hypertension before admission
will require higher CPP)
, Mannitol vs. Hypertonic Saline chart
Never give mannitol to someone with cerebral vasospasms
because it will act as a diuretic and worsen the cerebral
vasospasm.
However mannitol is the agent of choice for treating elevated
ICP as per TBI guidelines. Should be 1st line as soon as injury
happens. then when pt is stabilized then preferred medication
would be hypertonic saline.