Increased Intracranial Pressure Paper

❑ To maintain cerebral blood flow (CBF), it is necessary to keep cerebral perfusion pressure (CPP) in the range of 60 – 100 mm Hg. When auto regulation is impair red, the CBF fluctuates with changes in the systemic blood pressure. This may be seen in the patient that is suctioned or who coughs, which causes a rise in blood pressure, resulting in elevated ICP. MAP that is greater than 60 mmHg is enough to sustain the organs of the average person. MAP is normally between 70 to 110 mmHg. If the falls below this number for an appreciable time, vital organs will not get enough Oxygen perfusion, and will become ischemic. A CPP less than 50 mmhg is

The purpose of this case study is to examine the specific case study of a 40 year old male who suffered a traumatic brain injury as the result of a fall from a roof. For future reference the term "Traumatic Brain Injury" will be abbreviated here as TBI and "Intracranial Pressure" as ICP. In this study we will explore the medical findings that are common in such an injury and how they relate to the Paramedic in the field. The specificity of this case will be broken down to define relevant terminology and findings that were present to the paramedics that responded to this call. Lastly, TBI's will be explored and discussed for their relevance in the field, contributing factors and comorbidities as they relate to paramedicine.

In this paper, I will be discussing ways to test Mary’s brain injury. Mary obtained her brain inju-ry by diving in a pool and hitting her head. Mary was shortly removed from the pool and sent to the hospital by the ambulance. Mary was unconscious for quite a while, but the next day re-gained consciousness. However, with the Glascow Coma Scale, Mary’s injuries will be tested and below you will find out how.

Recovery is a long ongoing process, based on many mechanisms that remain uncertain for an extended period of time. TBIs are also unique because no brain injury is like another, and the consequence of two almost identical injuries may be completely different depending on the person. Symptoms may appear almost immediately or may not present themselves for days or weeks after the initial injury. Individuals of all ages, background, and health status are susceptible to TBI. This paper will discuss the pathophysiology of TBI, nursing care management, and community resources available in WNY for individuals who suffer from TBI. There will also be three evidence based research articles summarized regarding TBI. The articles are as follows: Managing Patients with Severe Traumatic Brain Injury by Devon Lump;(ADD ANOTHER ARTICLE); and Understanding the Pathophysiology of Traumatic Brain Injury and the Mechanisms of Action of Neuroprotective Interventions by

Considering the high mortality in the intensive care unit in hospitals compared to other units as well as the high costs of inpatient treatment in these units, mortality prediction has long been a concern [3]. In recognition of these problems, various scoring scales have been proposed and validated. However, no score has been used as a gold standard and some are difficult to use [4]. The most commonly used scale is Glasgow Coma Scale (GCS) [5]. Lately Full Outline of Unresponsiveness (FOUR) score has been validated and is being used as an alternative to GCS in evaluation of consciousness in severely brain damaged patients [2].

Colton et al. (2014) research looked at 117 clients who experienced increase intracranial pressure as a result of severe traumatic brain injury. Their research looked at client’s respond to pharmacological interventions and these pharmacological interventions include hypertonic saline, mannitol, propofol, fentanyl, and barbiturate. In their research Colton et al., (2014) found “all treatment resulted in significant intracranial pressure changes after 1 hour or 2 hours except for mannitol and barbiturate administration” (Colton at el., 2014). This finding is significant given that mannitol is used as a first line treatment for management of increased intracranial pressure. The chart below demonstrates how each of these pharmacological interventions decreased intracranial pressure and it allows us to compare each pharmacological intervention to each other. (Colton et al., 2014)

For example, if the patient’s trachea has been crushed, the treatment would be to make sure a patent airway is regained. After the initial cause has been addressed, the resulting symptoms will be addressed such as prescribing anti-seizure medications for any seizure activity, providing barbiturates to slow brain activity which gives the brain time to heal, and keeping the environment cool to prevent further brain damage. Rehabilitation options are also available if complete brain death has not occurred and include speech, physical, occupational, and recreational therapies. The nursing assessments and plan of care are once again going to depend largely on the symptoms of the brain injury and will need to be individualized. (Anoxic Brain Injury,

Use of mannitol versus hypertonic saline in the reduction of intracranial pressure in adults with traumatic brain injury.

The first being if the patient is unresponsive using the AVPU method in a pre-hospital or emergency environment. This will allow health professionals to determine the specific level of consciousness and decide if further care, such as intubation, is needed [3]. Essentially the AVPU model is a simplified version on the GCS model that allows health professionals to quickly assess a patient’s level of consciousness in a short amount of time [4,6]. With the management of patients with a neurological emergency the GSC method should be applied because it is a more thorough procedure and is more accurate in assessing the change in a level of consciousness

The severe head injury is one of the most frequent problems encountered by the anesthetist-resuscitator in first aid, in transport, in the emergency room and in intensive care.

In general, it is agreed that a TBI with a GCS of 13 or above is mild, 9–12 is moderate, and 8 or below is severe. A person with any type of TBI or head injury requires immediate medical treatment before it gets worst. There are many ways to diagnose a person with a head injury. One of which is using brain scans, it is used to scan a patient 's brain and determine how serious the injury is, and also to determine if that person needs immediate treatment to cure that damage, treatment includes surgery for most cases or other ways in normal brain injuries. (“Traumatic Brain Injury: Hope Through Research”).The best test in the emergency situation is computed tomography (CT) as it is, accurate, quick, and widely available. Even though MRI or Magnetic Response Imaging is the best way to find if there is any type of brain damage because it gives a very detailed and accurate results than a Computed Tomography (CT) scan would give.However, it is not used in the emergency setting for reasons including its incapability in detecting fractures and bleeds, its lengthy acquisition of images, and its incompatibility with metal items used in emergency care. At the University of California San Francisco, in an article, Bardi states,“All 135 patients with mild traumatic brain injuries received CT scans when

correlate poorly with the level of consciousness, as measured by the Glasgow Coma Scale, in

The purpose of the second study conducted by Clifton et al. (2011) was to determine whether early introduction of hypothermic intervention would improve outcomes in patients with severe brain injury. The method used for this study is a randomized, multicenter trial (Clifton et al., 2011). A sample size of 232 patients was used to randomly assign to hypothermia or normothermia groups after the first set of inclusion criteria and exclusion criteria. The patients had to be between the ages of 16 and 45, have a non-penetrating brain injury, and non-responsive to instructions to meet the inclusion criteria (Clifton et al., 2011). The first set of exclusion criteria that was set forth by Clifton et al. (2011) includes: “suspected pregnancy, systolic blood pressure less than 110 mm Hg, sustained heart rate greater than 120 beats per minute, of if they could not be reached by study-affiliated personnel within 2.5 h or injury” (p. 132). After a

A coma is a prolonged state of unconsciousness which a person is unresponsive to his or her environment. The patient is practically alive but can’t perform any kind of movements including talking in some cases. One major reason for this type of occurrence would be a drastic injury to the brain. This cause can be led by various factors such as increased pressure, bleeding, loss of oxygen, or buildup of toxins. Nobody actually knows if a patient will wake up after a coma or if he/she will take numerous amounts of months or years to do so. It is commonly known that more than 50% of comas are related to head trauma or disturbances in the brain's circulatory system. (Lava2) There are numerous amounts of reasons that can lead to a coma such as a stroke, blood sugar problems, infection, seizures and much more!

Doctors will assess the head injury with the GCS (Glasgow Coma Scale). GCS is 15-point test which assesses the mental status. The high GCS score specify a less severe head injury. Doctors will examine the signs and symptoms of trauma, bruising and swelling. Neurological examination helps to evaluate the nerve function through muscle control and strength the eye movement and sensation and other things. Some time CT scan and MRI scans are used in sever conditions.