Summary of Recommended Practices
Decrease intracranial pressure
- Evacuate mass occupying hemorrhages
- Consider draining CSF with ventriculostomy when possible
- Hyperosmolar therapy, +/- diuresis (cautious use to avoid hypovolemia and decreased BP)
- Mid-line neck, elevated head of bead (some research supports elevation not > 30 degrees)
- Treat pain and agitation - consider pre-medication for nursing activities, +/- neuromuscular blockade (only when needed)
- Careful monitoring of ICP during nursing care, cluster nursing activities and limit handling when possible
- Suction only as needed, limit passes, pre-oxygenate / +/- pre-hyperventilate (PaCo2 not < 30) / use lidocaine IV or IT when possible
- After careful preparation of visitors, allow calm contact