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Posts tagged ‘ICP’

Chapter #4 Part 3: Intracranial Pressure (ICP)

Assalamu`alaikum and greetings to all…

It has been a long day since my last post on my clinical experience. For the past three months I worked in an “office”. No patients involved. Most of the time, I was sitting on a plastic chair and working on research paper, conducting workshop and even became the speaker. However, I have to come back to ward during Hari Gawai celebration due to shortage of staff. For the first time in my life as a staff nurse I attended CME which meant for doctors and not nurses. Some of the take home messages that I managed to grab from our Head of Neurosurgery – Mr Arshad Ali :

ICP – Defined

The pressure that is exerted on to the brain tissue by external forces such as cerebrospinal fluid (CSF) and blood.


Intracranial pressure (ICP) is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid (CSF).

Normal Pressure as per Age

Adult: 10-15 mmHg / 135-200 cmH²O of water

Children: 3-7 mmHg

Infants: 1.5-6 mmHg

Neonates: < -2 mmHg

ICP Monitoring Gadgets






Checking Patency of ICP Device

Hepato-cephalic reflex

Jugulo-cephatic reflex

Compressing directly on brain

CR – Defined

Cerebral protection interventions aimed to reduce neuronal injury that instituted before possible ischemic / hypoxic event.

Cerebral resuscitation interventions that occur after such event.

Optimum Cerebral Resuscitation

Adequate Sedation that patient has:

No movements / motor response

No respiratory effort

Mean Arterial Pressure (MAP) = 90 mmHg

Partial pressure of CO² (PCO²) = 30-35 mmHg

Use of Propofol-Fentanyl OR Midazolam-Morphine for CR

Central Venous Pressure 10-12 mmHg

Adequate nursing management – elevate HOB 30°, head in neutral position

Cranial Cavity

80% brain tissue

10% CSF

10% blood (venous volume and arterial volume)

Monro-Kellie Doctrine (Volume-Pressure Relationship)

V blood + V brain + V CSF = Constant

Cerebral Perfusion Pressure


Normal: 90 – 10 = 80

Cushing’s: 100 – 20 = 80

Hypotension: 50 – 20 = 30

Cerebral Perfusion Pressure ≠ Cerebral Blood Flow

Cushing’s Triad

↑ Systolic BP

↓ Pulse

↓ Respiration


Any GCS and pupillary changes – INFORM!

Any ICP ≥ 20 mmHg – INFORM!

Any CSF drainage ≥ 20ml per hour – INFORM!


Brain is like a walnut shaped. It’s not round like a ball.

Until we meet again.

May peace be upon you.

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