Raised intracranial pressure (ICP): management in emergency department.
Raised intracranial pressure is a life threatening condition; unless recognized and treated early, it may progress into herniation syndrome and death. Symptoms and signs are neither sufficiently sensitive nor specific, hence a high index of suspicion and vigilance are needed for early recognition. Immediate goal of management is to prevent / reverse herniation and to maintain good cerebral perfusion pressure. The therapeutic measures include stabilization of airway, breathing and circulation, along with neutral neck position, head end elevation by 30°, adequate sedation and analgesia, minimal stimulation, and hyperosmolar therapy (mannitol or 3% saline). Short-term hyperventilation (to achieve PCO(2) ≈ 30 mm Hg) using bag ventilation can be resorted to if signs of impending herniation are present.
Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
Ramesh Kumar R
Sunit C
SC
Singhi
Pratibha
P
Singhi
D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D003906:Developing Countries; D004636:Emergency Service, Hospital; D004677:Encephalocele / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015600:Glasgow Coma Scale; D006801:Humans; D007194:India; D007223:Infant; D019586:Intracranial Hypertension / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate