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What is In a 40 years old patient with head injury, which of the following is the best strategy to decrease the intracerebral pressure? and explain in detail?
Ans:. a. Limiting pCO, of the patient(Ref Harrison 19/e p1780, 18/e p2257)Hyperventilation and decreasing pCO2 is the initial and one of the most impoant treatment strategies to lower the ICP in a patient of head injury.For ICP >20-25 mmHg for >5 minPressor therapy - Phenylephrine, dopamine, or norepinephrine to maintain adequate MAP to ensure CPP 60 mmHg (maintain euvolemia to minimize deleterious systemic effects of pressors)Consider second-tier therapies for refractory elevated 1CP:High-dose barbiturate therapy ("pentobarb coma")Aggressive hyperventilation to PaCO2 <30 mmHgHypothermiaHemicraniectomy