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PEDIANeurologic Disorders
Increased ICP - INTRACRANIAL PRESSURE
NORMAL: 5-15 mmHg
- Crushing’s Triad (Hypertension, Bradycardia, bradypnea) Hyperbradybrady
- Widened pulse pressure
- 120/80 -> 120- 80 = 40 (pulse pressure
NORML: 30 - 40
- 180/100 = 80 -> WIDENED PULSE
S/sx
EARLY SIGNS:
INFANT: High pitch cry CHILD: Irritability, agita on
ADULT: Restlessness GERIA: confusion
Young children
1. Bulging fontanels - aggravated by crying
-ANTERIOR - DIAMOND, closes 12-18 months
- POSTERIOR - TRIANGULAR 2-3 months
2. High-pitched cry - Early signs
( Ini al sign: headache)
3. Increased head circumference
- tape measure in bedside table
- every shi (8 hours)
- projec le vomi ng :compression of medulla - > CTZ ( chemoreceptor trigger zone):
vomi ng center -> Cerebral edema
- Diplopia - presence of double vision -> inc. of ICP = inc of IOP -> Op c nerve
damage-> blurring of vision -> blindness
- Eyes: Pupillary changes: PERRLA ( Pupil equally round and reac ve to light and
accommoda on )
- Anisocoria - uneven pupils = Brain damage
- Dilated -signs of shock
- Constricted - narco c overdosed
* Sunset eyes
, Older Children
1. Headache - Ini al sign
2. Projec le vomi ng :compression of medulla - > CTZ ( chemoreceptor trigger zone):
vomi ng center -> Cerebral edema
3. Declining school performance
4. Inability to follow simple commands
5. Diplopia and blurred vision - presence of double vision -> inc. of ICP = inc of IOP -> Op c
nerve damage-> blurring of vision -> blindness
6. Anorexia, nausea, weight loss
7. Seizures
a. Inc. neuronal ring - erra c transmission impulses -> seizures
b. Vomit -> DHN -> inc temp. -> convulsions -. seizures
Late manifesta ons
1. Decreased LOC (lethargy to coma)
2. Abnormal sensa on to pain s muli
3. Anisocoria
4. Decerebrate – midbrain dysfunc on
Manangement:
- Posi ons : semi fowlers - ICP will decrease by gravity
- Coughing and sneezing is avoided
- Limit uid intake: 1,200- 1500/ day
Pharmacotherapy:
- Diure cs: (Potassium was ng -> monitor K levels (Hypokalemia)
- Loop ( Lasix): Localized (HINT: LLL)
- Osmo c ( Mannitol): (osmosis- pulling pressure) : Generalized
- Decadron ( Dexamethasone):(An in ammatory) -> cerebral edema
- An convulsants: minimize seizures episodes
- Antacids: (Due to to GI irrita on from steroid usage (decadron))
- Mg Hydroxide - Diarrhea (MG TAE)
- Al Hydroxide - Cons pa on (AL ang TAE)
- An coagulants: to avoid Thromboembolism
- Heparin: IV/Sub Q -> PTT ( par al thromboplas n me)
- Warfarin: oral -> PT ( PROTHROMBIN TIME)
*** REMEMBER: OPIATES AND SEDATIVES are CONTRAINDICATED IN one ICP***
- Crushing’s Triad (Hypertension, Bradycardia, Bradypnea) -> resp. and cardiac depression.
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