sicuorientation.ppt

Increased ICP Step 3: Initiate Hyperosmolar therapy Mannitol and Hypertonic saline May cause renal insult if hypovolemic Hypernatremia 160 not associated with increased morbidity and mortality Mannitol dosing: 1gm/Kg q 6 H and hypertonic saline 23.4% may be substitute in certain cases When using mannitol monitor clearance BID osmotic gap: hold or increase/extend interval or alternate hypertonic saline if gap 20 Refer to physician guidelines in CPG Increased ICP Sedation and Pain control Consider CSF Drainage Consider Cerebral Perfusion Pressure CPP management for goal 60 mmHg if unable to keep ICP 25 CPP MAP - ICP Consider neurocritical care consult Limit patient stimuli May use hyperventilaton briefly until progress made to reduce ICP Increased ICP Step 4 Increase to Deep Sedation RASS -4 to -5 If this fails, obtain CT scan to evaluate for surgical lesion May use hyperventilation briefly; downside: cerebral ischemia Increased ICP Step 5 Induce pharmacologic coma a rescue therapy Pentobarbital drip Propofol drip Monitor continuous EEG: Consider long-term hyperventilaton hours-days to achieve pC02 30-35: MAY CAUSE CEREBRAL ISCHEMIA Induce hypothermia 34 – 350 C If step 5 fails, obtain CT scan to evaluate for surgical lesion Increased ICP Step 6 Consider inducing paralysis or Evaluate for salvage surgical procedure craniectomy, if not already considered Therapeutic Hypothermia for Comatose Survivors of Cardiac Arrest 2005 AHA Guidelines indicate instituting mild hypothermia improves neurologic outcome Scope: All patients 18 and older who remain comatose post-VF cardiac arrest, with return of pulse pressure Excluded: major head trauma, recent major surgery, sepsis, bleeding, pregnancy Pressure Ulcer Care CPG PREVENTION including ordering air mattress/specialty bed on high risk patients Daily skin assessment with report to clinical staff by nursing with weekly PU reports Education for residents, midlevels and nursing staff Pressure Ulcer C