INTRACRANIAL  HYPERTENSION

Despite controversy on the use of invasive monitoring to measure ICP, treatment of known or suspected intracranial hypertension remains a cornerstone of therapy in patients with severe brain injury.42

Intracranial hypertension should be suspected based on certain clinical criteria if no CT scan or intracranial monitor is available. These criteria include:

If treatment for intracranial hypertension is indicated prior to arrival to a neurosurgical capability, initiate hyperosmotic therapy with one of the following:

1. Hypertonic Saline42,43 (Appendix B)

2. Mannitol

Avoid Mannitol during the initial resuscitation period when ongoing bleeding has not been ruled out and in hypotensive casualties (or any casualty with the risk of bleeding).  

Consider using Mannitol only if there is no availability of hypertonic saline and there is a significant concern for imminent herniation as evidenced by signs of intracranial hypertension described above.