- See:
Spinal Shock
- Discussion:
- fluid resuscitation should be conducted with the knowledge that
excessive replacement may cause cerebral edema;
- expanded intravascular volume in absence of abnormality in serum Na
does not predispose to brain swelling, and hence, fluid restriction
is not indicated in the head injury;
- hypertonic saline (which temporarily reduces intracranial pressure)
and Ringer's lactate are the fluids of choice until cross-matched
whole blood is available;
- systolic arterial pressure should be maintained above 80 mm Hg to
ensure adequate cerebral blood flow;
- w/ intravascular volume stabilized, fluid intake should be restricted
to maintenance requirements;
- strict temperature control is maintained to limit fluid requirements
and prevent pernicious increases in brain metabolic activity;
- Labs:
- Hyponatremia:
- occurrence of SIADH or diabetes insipidus renders pt with head
injury prone to serious electrolyte abnormality;
- hyponatremia resulting from SIADH or overzealous fluid replacement
is particularly harmful, as sodium levels beloww 130 mEq/L
promote cerebral edema and can precipitate seizures;
- Osmolarity:
- serum osmolarity above 320 mosm/L is avoided because of
cardiopulmonary and renal complications;
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Contribution of increased cerebral blood volume to posttraumatic
intracranial hypertension.
An analysis of the relationship between fluid and sodium administration
and intracranial pressure after head injury.
Hypertonic Fluid Resuscitation Improves Cerebral Oxygen Delivery and
Reduces Intracranial Pressure After Hemorrhagic Shock.
The Deleterious Effects of Intraoperative Hypotension on Outcome in
Patients With Severe Head Injuries.
