- Early consultation with a neurosurgeon to guide medical management and address surgical causes of elevated ICP*
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- Secure the airway using RSI (use cervical spine immobilization in trauma patients) for the following:
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- GCS ≤8 or <12 and rapidly declining
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- Loss of airway protective reflexes
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- Rapid treatment of hypoxia, hypercarbia, and hypotension
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- Elevation of the head 15 to 30 degrees while maintaining the head in a midline position
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- Aggressively treating fever with antipyretics and cooling blankets
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- Control of shivering in intubated patients with muscle relaxants (eg, vecuronium, rocuronium)
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- Administering prophylactic antiseizure medications (eg, levetiracetam, phenytoin, or phenobarbital) to patients who are at high risk of developing seizures
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- Maintaining adequate analgesia to blunt the response to noxious stimuli
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- Maintaining the head in a midline position and taping, rather than tying endotracheal tubes to the face
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- Avoiding high positive pressures and end expiratory pressures
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- Maintaining adequate sedation and, in some patients, muscle relaxation to permit controlled ventilation
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- Administration of lidocaine (1 mg/kg intravenously) before endotracheal tube suctioning to blunt the gag and cough responses
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