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
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
80% brain tissue
10% blood (venous volume and arterial volume)
Monro-Kellie Doctrine (Volume-Pressure Relationship)
V blood + V brain + V CSF = Constant
Cerebral Perfusion Pressure
MAP – ICP = CPP
Normal: 90 – 10 = 80
Cushing’s: 100 – 20 = 80
Hypotension: 50 – 20 = 30
Cerebral Perfusion Pressure ≠ Cerebral Blood Flow
↑ Systolic BP
Any GCS and pupillary changes – INFORM!
Any ICP ≥ 20 mmHg – INFORM!
Any CSF drainage ≥ 20ml per hour – INFORM!
Until we meet again.
May peace be upon you.