Intracranial Hypertension - Medical Case Study

The preceding discussion covers case study three that involves the 19-year-old U.S Air Force driver. As mentioned in the case, the driver was involved in a car accident and is now in the ICU with a closed head injury (meaning that the injury did not penetrate the skull). Medical tests indicate that his intracranial pressure (ICP) has drastically risen. Markedly, the normal ICP is 7-15mm HG. According to Dunn (2010), the increase in the ICP results from an increase in cerebral blood volume, and this can lead to brain infarction and Ischemia (Dunn, 2010). Besides, his efferent pupillary response is slowing which is a clear symptom of elevated intracranial pressure. Thus, it is apparent that the patient is suffering from a neurologic condition referred to as intracranial hypertension which results from elevated ICP.

To control ICP, it is important first to ensure that the patient is hyperventilated. For proper hyperventilation, the head of the bed should be elevated to 300 (Richardson, 2013). This technique is also known to improve the lower ICP. It should be noted that this is a temporal measure while other methods of controlling intracranial pressure are being initiated. The next mechanism of managing the anticipated increase in ICP is through osmotic diuresis. This process essentially entails drainage of edema from the cerebral parenchyma and should take 15-30 minutes (Sahuquillo, 2006). To avoid acute renal failure, the serum osmolarity level should not be greater than 320mOsm/kg.

Succeeding the above therapies, it is pivotal to make sure that there are no muscle activities that may further cause an increase in ICP. This may include an increase in the intrathoracic pressure or blocking of the cerebral venous drainage process (Neuromuscular blockade) (Richardson, 2013). Also, in this category of first-line medications, it is recommended that one apply drugs that have sedation and analgesia effects. In particular, the drug that is suggested for the latter effect is morphine, and the dosage should be 0.05mg/kg1M per every 6 hours. The recommended drug for the sedation effect is midazolam and should be 1-2 mg every 4 hours to the maximum of 0.1 mg/kg (Richardson, 2013). Lastly, in this set of therapy, it is advisable to administer intravascular Mannitol. The drugs have beneficial effects in controlling raised ICP. The drugs work by decreasing blood viscosity (Yavin et al., 2014). This ensures intracranial vasoconstriction. According to Monroe-Kelly hypothesis, this process causes a decrease in intracranial volume consequently decreasing the ICP.

Notably, administration of the afore-discussed medications will ensure that the situation is controlled. In fact, at the end, it is likely that the patient will have awakened. However, this does not suggest that the patient has fully recuperated, and thus it is fundamental to recommend further medications. In this case, firstly, I suggest administration of barbiturates. For oral dosage (capsules and tablets), administer 65-200 mg per day (Fourati et al., 2017). The drugs are known to lower the ICP. Notably, the drugs are potentially harmful (pose significant risks including hypotension) hence should not be used as first-line treatment drugs. Also, the patient should take undergo a surgical therapy, in this case, a decompressive craniectomy, to ensure that the ICP level is fully controlled.

Finally, I find it prudent to explore on some the strategies that I believe are crucial in treating and managing neurologic and orthopedic conditions. Firstly, it is important that when such conditions occur, it is first important to rush the patient to the nearest health center. Try to cover the place that could be bleeding to avoid excessive oozing of the blood. Lastly, treatment of these conditions depends on the cause and hence varies a lot.

References

Dunn, L. T. (2010). Raised intracranial pressure. Journal of Neurology, Neurosurgery & Psychiatry, 73(suppl 1), i23-i27.

Fourati, Z., Ruza, R. R., Laverty, D., Drege, E., Delarue-Cochin, S., Joseph, D.,& Delarue, M. (2017). Barbiturates bind in the GLIC ion channel pore and cause inhibition by stabilizing a closed state. Journal of Biological Chemistry, 292(5), 1550-1558.

Richardson, J. (2013). Clinical and neuropsychological aspects of closed head injury. Psychology Press.

Sahuquillo, J. (2006). Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. The Cochrane Library.

Yavin, D., Luu, J., James, M. T., Roberts, D. J., Sutherland, G. R., Jette, N., & Wiebe, S. (2014). Diagnostic accuracy of intraocular pressure measurement for the detection of raised intracranial pressure: meta-analysis: a systematic review. Journal of neurosurgery, 121(3), 680-687.