Head Bleeds & Increased ICP

What is an epidural bleed?

Collection of blood between the cranium and dura in the epidural space

What type of bleed is an epidural hematoma?

Arterial bleed

Most common vessel involved in an epidural bleed

Middle meningeal artery

Classic presentation of an epidural bleed

Transient loss of consciousness, lucid interval, then decreasing LOC

What is a lucid interval?

Return to normal neurologic status after transient loss of consciousness

Signs and symptoms of an epidural bleed

Headache, decreasing LOC, increased ICP, Cushing’s Triad

What is a subdural bleed?

Collection of blood between the dura and arachnoid mater

What type of bleed is a subdural hematoma?

Venous bleed

Which is more common, epidural or subdural bleeds?

Subdural bleeds

How do symptoms typically develop in a subdural bleed?

Slow onset

Signs and symptoms of a subdural bleed

Nausea/vomiting, headache, decreasing LOC, coma, posturing

What is a subarachnoid bleed?

Intracranial bleeding into the cerebrospinal fluid (CSF)

Classic complaint of a subarachnoid bleed

Worst headache of my life

How does a subarachnoid bleed typically present?

Sudden and severe headache

How do symptoms typically develop in a subarachnoid bleed?

Slow onset

Signs and symptoms of a subarachnoid bleed

Dizziness, neck stiffness, unequal pupils, vomiting, seizures, decreasing LOC

What does Cushing’s Triad indicate?

Herniation and severe increased ICP

Normal ICP range

10–15 mmHg or less

Target SpO2 in increased ICP patients

Greater than 94%

Target ETCO2 in increased ICP patients

35–40 mmHg

When should hyperventilation be used in increased ICP?

If evidence of herniation is present

Target ETCO2 when hyperventilating for herniation

30–35 mmHg

Evidence of herniation

Cushing’s Triad

Additional evidence of herniation

Unresponsive patient with bilateral dilated pupils and decerebrate posturing with no motor response to painful stimuli

What should capnography be used for in increased ICP patients?

ETCO2 monitoring

What should be maintained above 94% in increased ICP patients?

SpO2

What finding with an epidural bleed commonly occurs before neurologic decline?

Lucid interval

What finding is common to epidural, subdural, and subarachnoid bleeds?

Decreasing LOC

What bleed is associated with a venous source?

Subdural bleed

What bleed is associated with an arterial source?

Epidural bleed

What bleed occurs within the CSF?

Subarachnoid bleed

What bleed is associated with neck stiffness?

Subarachnoid bleed

What bleed is associated with posturing?

Subdural bleed

What bleed is associated with unequal pupils?

Subarachnoid bleed

What bleed is associated with seizures?

Subarachnoid bleed

What bleed is associated with coma?

Subdural bleed

What bleed is associated with a lucid interval?

Epidural bleed

What bleed is associated with the middle meningeal artery?

Epidural bleed

What bleed is associated with the complaint “worst headache of my life”?

Subarachnoid bleed