MEASUREMENT AND MONITORING
PRESSURE INTRA cranial
Sectional HEAD
§ Intra Cranial Pressure
• ICT is the pressure caused by the addition of volume within the cranium
• The contents of the cranium are:
86% of brain tissue,
CSF of 10%
4% of blood
In other words
Total blood volume = Volume + Volume + Volume of brain CSF
• Hypothesis Monro kelly:
If there is an addition to the other component parts of the brain will adjust so that the brain volume remains constant.
• If the compensation limit exceeded slight increase in volume will result in an increase in ICT
In other words
Total blood volume = Volume + SCF + Volume Volume Volume + brain tumor
• The normal value of ICT is 1-15 mmHg
§ ICP NORMAL VALUE
Newborn § 0.7 to 1.5 mmHg
Infant § 1.5 to 6 mm Hg
§ Children 3 to 7.5 mmHg
§ Adult 1-15 mm Hg
§ Relationship Between Compliance and ICT
§ meninges (membranes surrounding the brain)
A layer of the meninges (connective tissue) that covers the brain and spinal marrow.
☺ Piamater
☺ arachnoid
☺ dural
§
§ Brain blood flow (CBF)
§ The brain receives ± 15% of cardiac output
± 800 ml of blood flow to the brain
CBF ± 50 cc / 100gr brain / min.
§ The brain blood flow and function to bring 02 glucose for energy.
CBF is governed by:
§ cerebral autoregulation.
A. Stress / pressure
2. Chemistry (PCO2 and PO2)
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§ Maintained normal CBF at MAP 50-150 mmHg.
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§ MAP <50 mmHg → cerebral ischemia, cerebral infarction
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§ MAP> 150 mmHg
→ Damage to the defense of the brain, brain hemorrhage, brain edema
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Pressure autoregulation.
§ pressure autoregulation serves to maintain blood flow to the brain and the CPP in the range of certain MAP
§ The ability of the brain to maintain CBF at MAP between 50-150 mmHg, this process because of the contraction of smooth muscle walls of blood vessels of the brain in response to pressure changes.
§ If MAP <50 mmHg cerebral ischemia occur
§ If MAP> 150 mmHg kontriksi power damage blood vessels and CBF will rise suddenly, there is damage to the blood brain barrier and cerebral edema occurs and bleeding of the brain
§ In certain circumstances this autoregulation is lost in the event of pathological conditions such as head trauma, trepanation, bleeding, chronic hypertension, cerebral ischemia, cerebral infarct, edema surrounding brain tumors
§ In the conditions of loss of autoregulation in case of hypertension will increase CBF and hypotension will occur ischemia.kedua this resulted in an increase in ICT
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§ CBF ↔ PaCO2
§ CBF change at any time in the event of changes in PaCO2
§ CBF doubled in PaCO2 80 mmHg. means when the PaCO2 rises will occur vasodilatation
§ Decreased CBF when PaCO2 20 mmHg half. mean PaCO2 down will occur when vasoconstriction
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§ CBF ↔ PaO2
§ Changing the state of low PaO2 and little change in the high PaO2.
§ When PaO2 <50 mmHg causes cerebral vasodilation occurs to increase CBF.
§ Circulation css
§ physiology
Spinal fluid cerebrovascular (CSS)
§ Factors that influence CBF
§ sympathetic and parasympathetic, sympathetic and parasympathetic vasodilatation resulting in vasoconstriction resulting
§ increased blood viscosity so that CBF decreased
§ The temperature dropped causing cerebral metabolism decreased mean CBF fell
§ Age: the older the blood flow will increasingly fall
§ Causes of increased ICP
§ Edema of the brain
§ Surgery of the brain
§ Hidrocepalus
§ Mass in the brain
§ Bleeding in the brain
§ SIGNS AND SYMPTOMS INCREASING intracranial pressure
§ Dizziness
§ Vomiting
§ Decrease in consciousness
§ Trias chusing
(Hypertension, bradicardia, impaired breathing pattern)
§ herniation of the brain
§ Management of ICT increases
§ Intubation
§ Control of ventilation by maintaining a PO 2 <35 mmHg
§ Volume resusitation
§ Normal blood pressure
§ normal CPP
§ Normalised ICP
§ Provide sedation
§ bolus of mannitol
§ Prophylactic anti seizure: Penitoin
§ Monitoring
§ Monitor the ICP
§ Monitor CVP
§ Monitor the CPP
§ Monitor Pulse oximetry
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§ ICP MONITORING
§ icp monitoring objective is to determine directly the value of Seara intra cranial pressure (ICP) that can be calculated CPPnya value, because the CPP is essential for cerebral blood flow indicator.
§ Monitorning ICP can be through sub aracnoid, epidural, or intraventricular brain intraparenkim
§ masnig Each location has its advantages and disadvantages.
§ Advantages and disadvantages
§ Ventrikulostomy
§ Installation of ventricular catheter into the lateral ventricle.
§ Indications:
1.COB with GCS <7 or less with unstable hemodynamics with CT scans could not be examined
2.COB with normal CT scan with age> 40 years there are signs of SBP <90 mmHg with abnormal posture changes
3.COB difusse injury with damage
4.Secondary cerebral injury
5.Untuk monitor the effects of therapy to lower intracranial pressure sepoerti: Hyperventilation, diuresis, in patients with high ICT
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§ Contra Indications:
§ Thrombocytopenia (<50,000)
§ the freezing extends
§ There is an open wound near the site of insertion
§ imunosupressi
§ Installation Destination
§ To drain excess CSS
§ For external mendrainage
§ Monitor the intra cranial pressure.
§ Old installation
5-10 days, should be replaced every 5 days
Criteria for the release of ICP monitor
ICP-normal with no other therapy after 24 hours
-Increase in GCS> 9
§ Insertion Locations ICP
§ Point Kocher
Intersection:
Mid pupillary line perpendicular to the
3-4 cm lateral sagittal suture and 1 cm in the anterior sutura coronaria
§ ventriculostomy
§ How pegukuran ICP
§ Using the transducer and monitor
§ Passive
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§ ventricle Drainage and ICP Monitoring
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§ HOW TO MEASUREMENT ICP
1.Atur position of the patient as comfortable as possible.
2.Petugas wash hands
3.Pasang manometer on the IV pole
4.Ukur by using a water fitting to the zero point on the manometer (ventricles) are the temples of patients / acusticus external meatus
5.Titik equate to zero in patients with a zero point in using a water manometer fitting
6.Buka three way from the ventricle into the manometer while in view undulasinya.
7.Tunggu until the flow stops
8.Setelah stop the flow of reading on the manometer.
9.Kemudian three way back to its original position towards the reservoir
10.Petugas wash their hands and blame the results of measurements
11.Alat device cleared
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§ Conversion of Measurement ICP / CVP
§ 1 mmHg = 13.6 mmH20 = 1.36 CmH2O
§ 1 cm H2O = 0.74 mmHg
§ How to calculate the conversion from cmH2O mmHg
5 CmH2O = 5 CmH2O
1.36
= 3.7 mmHg
Another way:
CmH20 5CmH2O = 5 X 0.74 mm Hg = 3.7 mmHg
RISKS AND COMPLICATIONS OF INSTALLATION § ICP
§ Intracerebral Hemorrhage with ivh
§ ICT> 20 mmHg
§ Installation of> 5 days
§ irrigation system at the catheter is not smooth or clogged
§ Infection
§ Complications ventriculostomy
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§ Care Objectives:
§ Preventing the ICT ↑ caused by body position, changing the physical state and the disease process
§ Treatment:
§ Neurological Examination
§ GCS, pupils, light reflexes, vital sign observation.
§ Setting the position of Head Up heads 150-300 and straight neck position
§ Maintain periodic aseptic measures in wound care
§ Maintain a closed system.
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Care
§ Peimmeriksaan kepatenan airway
§ Maintain a supine patient position monitor function accurately sewhingga
§ Do not manipulate the drainage system
§ Avoid excessive stimulation in patients
§ Maintenance drainage continuously
- Note the periodic undulations of the following pulse.
-Place the container in accordance with the principles of sterile normal.hankan ICT
-Maintain the principle of sterile
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