This is some quick info on a few very common meds you run into in the neuro intensive care unit. However, please always follow your hospital’s policies and procedures. This is for informational purposes only and focuses on nursing considerations.. not going in depth on the drug.
Why we love it: it works quickly and wears off quickly, allowing us to get a quick neuro assessment. You can detect changes quickly, which is essential.
Work with your dietician to ensure your enteral feeding formula is appropriate. If you are weaning it or increasing it significantly, they may need to change it. Lots of calories!
Always flush the line – never pause and leave for a while.. it will clot your line!
Titrate to clinical response – don’t just coast. Back off if you need to, increase if you need to.
Mannitol is an osmotic diuretic given to decrease ICP. It doesn’t cross BBB. You increase the plasma osmolality to pull fluid off the brain and out of the body. It increases intravascular volume (pulls fluid into the vessels) and therefore cardiac output.
Interesting fact: it’s actually a sugar alcohol also used in the food industry. It’s a naturally occurring substance found in marine algae and mushrooms.
Used to treat hyponatremia and cerebral edema.
Basically it is salt water. Some docs will use this, some will use mannitol for increased cerebral edema. Evidence is not super awesome about if one is much better than the other.
Watch for a rapid increase in sodium. Shouldn’t rise more than 8-12 mmol/L. in 24 hours. Otherwise central pontine myelinolysis can occur.
Severe damage of the myelin sheaths of the nerve cells in the brainstem. A BIG deal. They can become paralyzed and die. Extent of damage depends on how many axons get damaged.
Be sure to check out Week 1: Neuro Assessment and Week 2: ICU Time Management.