EMCrit Podcast Podcast 78 – Increased Intra-Cranial Pressure (ICP) and Herniation, aka Brain Code
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Jul 22, 2012 Explore the critical world of increased intracranial pressure (ICP) and herniation. Discover the innovative 'Brain Code' concept and the importance of optic nerve sheath ultrasound for early diagnosis. Learn about a tiered approach to ICP management, including essential neurocritical care measures and osmotic therapies. Scott Weingart discusses the role of mannitol and hypertonic saline, proper sedation techniques, and when to monitor ICP. Get insights on advanced therapies and how to effectively transition from emergency to ICU care.
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Bedside Optic Sheath Ultrasound
- Use ocular nerve sheath ultrasound to screen for raised ICP at bedside quickly.
- Measure 3 mm behind the globe; >6 mm suggests increased intracranial pressure.
Optimize Head Positioning
- Keep the head elevated and midline to promote venous drainage and lower ICP.
- Aim for 30–45 degrees head-of-bed and avoid turning the head to the side.
Aggressively Control Fever
- Control temperature aggressively because fever raises cerebral metabolic rate and ICP.
- Use cooling blankets or hypothermia programs when antipyretics fail and keep temperature near normal.