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ICP Head Injury
ICP Head Injury
PRESSURE
Increased Intracranial Pressure
A life threatening situation that results from an
increase in any or all of the three components
(brain tissue, blood, CSF) of the skull.
Brain tissues (space-occupying lesions) e.g. tumor,
abscess, edema
Blood supply – e.g. thrombosis, embolism, aneurysm,
A-V malformation
CSF – e.g obstruction to the flow caused by a brain
tumor, overproduction of the CSF due to tumor in the
choroid plexus.
Above the threshold of 20 mm Hg
CAUSES
Head injury
Brain tumor
CVA (cerebrovascular accident)
Hydrocephalus
Cerebral edema
Bleeding post surgery
Clinical Manifestations
1. Restlessness – initial sign of Increased ICP
2. Change in Level of consciousness
Unconsciousness – abnormal state of complete or
partial unawareness of self or environment.
Lethargic
Drowsy
Stupor
Motor/sensory change
Due to the affectation of ascending reticular activating
system (ARAS).
Clinical Manifestations
3. Changes in vital signs – caused by
increasing pressure on the thalamus,
hypothalamus, pons, & medulla.
irregular respirations
bradycardia with full & bounding pulse
widening pulse pressure
( CUSHING’S TRIAD)
Clinical Manifestations
4. Headache & irritability
5. Nausea & vomiting (projectile)
6. Pupillary Changes (Ocular signs)
brisk constriction – normal reaction
Anisocoria (inequality in the size of the pupil) due to CN
III compression. There is ipsilateral pupil dilatation.
Sluggish reaction - indicates early pressure on cranial
nerve III.
Fixed pupil – no response to light stimulus, indicates
uncal herniation. This causes compression of the
brainstem that results to respiratory arrest.
Pinpoint pupils – indicate pons involvement
Clinical Manifestations
•Inability to move the eye upward
•Ptosis of the eyelid
•Papilledema – (choked disk) swelling &
protrusion of the blind spot of the eye caused
by edema & compression of the optic nerve.
Tegretol (Carbamazepine)
Side effects: rash, ataxia, drowsiness
Antacids to prevent GI irritation which may
be induced by dexamethasone
Histamine-H2 receptor antagonists to
prevent stress ulcer
Anticoagulants to prevent
thromboembolism
NOTE: Opiates & sedatives are
contraindicated because they cause
respiratory depression & acidosis
THANK YOU!
Melania silva-banaticla,
rn,man
HEAD INJURY
includes any trauma to the scalp, skull, or
brain.
The term “Head Trauma” is used primarily to
signify craniocerebral trauma, which includes an
alteration in consciousness, no matter how brief.
Has high potential for poor outcome
Deaths occur at 3 time points after injury:
immediately after injury, 2 hours after injury &
approximately 3 weeks after injury.
Factors that predict poor outcome
Presence of intracranial hematoma
Increasing age of the patient
Abnormal motor responses
Impaired or absent eye movements or pupil light
reflexes
Early sustained hypotension
Hypoxemia or hypercapnia (presence of high
CO2 in the blood)
ICP levels higher than 20mmHg
Etiology
A. Blunt
Motor vehicle collision
Pedestrian event
Fall
Assault
Sports injury
B. Penetrating
Gunshot wound
arrow
Types of head injuries
1. Scalp Lacerations – most minor type of
head trauma.
Associated with profuse bleeding
because the scalp contains many blood
vessels with poor constrictive abilities
Infection is the major complication
Types of head injuries
2. Skull Fractures
linear or depressed
Simple, comminuted or compound
Closed or open