Bieber Posted November 10, 2010 Share Posted November 10, 2010 Looks like Cushing's response to me. Also with the other RSI drugs can we throw in some lidocaine for that ICP too? Also, what is his ICP? The flight to the hospital is going to be all about that airway, the head injury needs surgical correction. Did we find any other injuries? Link to comment Share on other sites More sharing options...
Timmy Posted November 10, 2010 Author Share Posted November 10, 2010 His ICP is 28mmhg. Nil further injury noted apart from ?spinal injury and clearly a sever head injury. Link to comment Share on other sites More sharing options...
Bieber Posted November 10, 2010 Share Posted November 10, 2010 (edited) Well, now that's getting pretty high, isn't it? Do we have a transport ventilator or are we gonna be bagging this guy all the way in? I'm not especially familiar with them, but if I'm not mistaken it's recommended to ventilate with a tidal volume of 6ml/kg to help reduce the incidence of ARDS (though I'm doubtful this kid'll last long enough for it to be a concern). Also, did the doctor at the local ER place a central line or an art line so we can keep an eye on those measurements as well (MAP and JVP)? Did we get any labs or imaging done before initiating transport? I'm interested in knowing the patient's serum osmolality and the location of the bleed, if available. If possible, let's transport with his head elevated at least 30-45 degrees if possible. You said he has a spinal injury, but he obviously still has vasomotor control intact so it's not a complete disruption. Were we able to assess neurologic function in the extremities before RSI'ing the kid? Did he have intact reflexes (+Babinski's)? Edited November 10, 2010 by Bieber Link to comment Share on other sites More sharing options...
Timmy Posted November 10, 2010 Author Share Posted November 10, 2010 You now have an Intensive Care Consultant and Intensive Care Paramedic who arrived on the chopper. The chopper has a ventilator. CVC is in. Nil imaging or pathology available. We question a spinal injury from MOI but defiantly has extremely strong and equal bilateral limb movement (takes 3 of your to hold down his arm to get the second IVC in). Reflexes were intact before RSI. As I said, there’s a positive spin to this story. What do you want to do with the ICP? Link to comment Share on other sites More sharing options...
Bieber Posted November 10, 2010 Share Posted November 10, 2010 You now have an Intensive Care Consultant and Intensive Care Paramedic who arrived on the chopper. The chopper has a ventilator. CVC is in. Nil imaging or pathology available. We question a spinal injury from MOI but defiantly has extremely strong and equal bilateral limb movement (takes 3 of your to hold down his arm to get the second IVC in). Reflexes were intact before RSI. As I said, there's a positive spin to this story. What do you want to do with the ICP? Why don't we try 1 g/kg of mannitol and see what that does? It'll reduce the ICP and increase the CPP, and if we have that art line and can get a MAP and if we can still keep an eye on the ICP (I assume they local ER doc put an ICP monitor in, though technically the patient doesn't meet the criteria for ICP monitoring, but since we got one earlier I'm assuming one's in place) we can get a CPP as well and have a better idea of where we stand. Ideally I'd like to get that ICP down to <20 mmHg and keep that CPP >60 mmHg, and maintain the patient's BP <160 systolic, which it's skirting the line right now so I'll leave it be. Link to comment Share on other sites More sharing options...
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