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Pharmacy & Acute Care University
Pharmacy & Acute Care University
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Emergency Medicine Trauma 212

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  1. Increased Intracerebral Pressure Reduction
    9 Topics
    |
    2 Quizzes
  2. Open Fracture Antibiotics
    8 Topics
    |
    2 Quizzes
  3. Spinal cord injury
    6 Topics
    |
    2 Quizzes
  4. Trauma resuscitation
    9 Topics
    |
    2 Quizzes
  5. Traumatic brain injury
    9 Topics
    |
    2 Quizzes

Participants 396

  • Allison Clemens
  • April
  • ababaabhay
  • achoi2392
  • adhoward1
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Increased intracerebral pressure is a critical condition that requires prompt and effective management. Pharmacotherapy plays a crucial role in reducing brain edema and stabilizing intracranial pressure (ICP). First-line treatments include osmotic agents like mannitol and hypertonic saline, while barbiturates are reserved for refractory cases. Individualized dosing, close monitoring of electrolytes and renal function, and consideration of comorbidities are essential. Guidelines from organizations like the Brain Trauma Foundation provide evidence-based recommendations. Clinical pharmacists play a vital role in optimizing medication regimens and ensuring patient safety.

References

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  2. Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6-15. doi:10.1227/NEU.0000000000001432
  3. Jain KK. Textbook of Hyperbaric Medicine, 6th ed. Cham, Switzerland: Springer; 2017.
  4. Oddo M, Levine JM, Mackenzie L, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery. 2011;69(5):1037-1045. doi:10.1227/NEU.0b013e3182289f81
  5. Diringer MN, Bleck TP, Claude Hemphill J 3rd, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15(2):211-240. doi:10.1007/s12028-011-9605-9
  6. Cottenceau V, Masson F, Mahamid E, et al. Comparison of effects of equiosmolar doses of mannitol and hypertonic saline on cerebral blood flow and metabolism in traumatic brain injury. J Neurotrauma. 2011;28(10):2003-2012. doi:10.1089/neu.2011.1885
  7. Rozet I, Tontisirin N, Muangman S, et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology. 2007;107(5):697-704. doi:10.1097/01.anes.0000287029.84358.5d
  8. Ichai C, Armando G, Orban JC, et al. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Med. 2009;35(3):471-479. doi:10.1007/s00134-008-1293-9
  9. Brain Trauma Foundation. Guidelines for prehospital management of traumatic brain injury. Prehosp Emerg Care. 2008;12 Suppl 1:S1-S52. doi:10.1080/10903120701732052
  10. Adelson PD, Wisniewski SR, Beca J, et al. Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial. Lancet Neurol. 2013;12(6):546-553. doi:10.1016/S1474-4422(13)70077-2
  11. Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents–second edition. Pediatr Crit Care Med. 2012;13 Suppl 1(Suppl 1):S1-S82. doi:10.1097/PCC.0b013e31825fb86c
  12. Faiver L, Hensler D, Rush SC, Kashlan O, Williamson CA, Rajajee V. Safety and Efficacy of 23.4% Sodium Chloride Administered via Peripheral Venous Access for the Treatment of Cerebral Herniation and Intracranial Pressure Elevation. Neurocrit Care. 2021 Dec;35(3):845-852. doi: 10.1007/s12028-021-01248-7. Epub 2021 Jun 25. PMID: 34173156.
  13. Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K, Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care. 2020 Jun;32(3):647-666. doi: 10.1007/s12028-020-00959-7. PMID: 32227294; PMCID: PMC7272487.
  14. Kerwin AJ, Schinco MA, Tepas JJ 3rd, Renfro WH, Vitarbo EA, Muehlberger M. The use of 23.4% hypertonic saline for the management of elevated intracranial pressure in patients with severe traumatic brain injury: a pilot study. J Trauma. 2009 Aug;67(2):277-82. doi: 10.1097/TA.0b013e3181acc726. PMID: 19667879.
  15. Burgess S, Abu-Laban RB, Slavik RS, Vu EN, Zed PJ. A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. Ann Pharmacother. 2016 Apr;50(4):291-300. doi: 10.1177/1060028016628893. Epub 2016 Jan 29. PMID: 26825644.