Question for tbi monitoring

[europeman]

For traumatic brain injury patients with gcs<8 and/or ivc or bolt monitor and on going icp issues managed successfully with propofol, fever control, and moderate osmolar therapy..... How often do YOU order your nurses to wake them up for a neuro exam? Q1 hour? Q4 hr? Q12? What is the patients icp always rises with awakening...... How often do you then wake them to check their neuro exam? Where I'm at it's almost always q1 hour which, I feel, is just way too much. Potentially harmful even as the overall elevated icp dose is more!

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[kenmc3]

Q1 typically and we allow transient ICP spikes during these exams into the 20s. If the patient is going much higher than that and/or taking a long time to return to normal we may extend the exams to q2hr (q4 at the most) with hourly pupillary exams. Its a delicate balance between high ICP and not knowing the exam of the patient. In the end all we know is that sustained higher ICP does seem to play a role in outcome... How much, who really knows?

 

[europeman]

Tks for reply.

Anyone else here do q4 or q8 hr exams when they have bordering icps which raise to low 20s say when u wake them?


Some places in the world they just out them down for several days without waking them up at all!