In a 40 years old patient with head injury, which of the following is the best strategy to decrease the intracerebral pressure?
Limiting pCO, of the patient
Administer sedatives
Oxygen supplementation by mechanical ventilation
Administer nimodipine
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