Intracranial pressure - stualis

[ArchivalUser]

What is the fastest method of lowering increased ICP?
1.Intubation
2.Hyperventilation
3.Mannitol
4.Head Elevation

I dont know the right answer....would just appreciate a discussion.

[ArchivalUser]

2.? ...but let me check.....

[ArchivalUser]

the act of performing intubation in itself....increases ICP and IOP!

[ArchivalUser]

mannitol

[ArchivalUser]

Hyperventilation.

[ArchivalUser]

i didnt understand that cricoid .....so are you saying that intubation increases rather than lowers the ICP?

[ArchivalUser]

I think head elevation... not the best, but the fastest to perform...

[ArchivalUser]

USMLE world says that in emergent situations mannitol and hyperventilation both can be used but which one should we chose if they give both since hyperventilation is a controversial topic.

[ArchivalUser]

Airway and ventilatory management Obtunded patients, especially those with a GCS ≤ 8 require intubation for airway protection. Mechanical ventilation will also facilitate deep sedation and hyperventilation. Hypercarbia should be avoided because it causes vasodilation and may further increase ICP. Therapeutic hyperventilation reduces ICP through vasoconstriction and reduced hyperemia. Although it is controversial, hyperventilation is rapidly effective but may lead to vasoconstriction with reduced CBF and may not be a reasonable long-term strategy. Therefore, it is recommended to maintain the PaCO2 at the low end of normal while more definitive strategies for reducing ICP are attempted.

[ArchivalUser]

I think hyperventialtion according to this link
http://books.google.com/books?id=A31JRSndVIYC&pg=PA498&lpg=PA498&dq=fastest+method+to+decrease+ICP+&source=web&ots=wEBSfp27m-&sig=LdbwDOYVkiODvcExwKS6OhuMiyc&hl=en