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CNS Mass Lesions

CNS Mass Lesions is a topic covered in the Pocket ICU Management.

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Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:

Anesthesia Central

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First Things First (assess & treat for the following)

Stabilization

  • Aspiration precautions/rescue position vs. airway protection/intubation
    • Glasgow Coma Scale (GCS) score < 8, head/neck/chest trauma, sig. cardiopulmonary disease, etc.: consider intubation
  • Adequate oxygenation/ventilation
  • C-spine protection/precautions (trauma)
  • Control seizures: phenytoin, barbiturates, benzodiazepines, levetiracetam
  • Cerebral perfusion pressure (CPP) maintenance
  • Hypotension: cautious volume repletion w/ normal saline (NS)
  • HTN: cautious IV antihypertensive therapy (labetalol, esmolol) to 160-180/80-90 level
  • Consider ICP-lowering maneuvers:
    • Elevate head of bed 30 degrees w/ neck neutral.
    • Modest hyperventilation to PaCO2 30-35 mmHg (if intubated)
    • IV mannitol bolus (0.25-0.50 mg/kg)
    • IV glucocorticoids (dexamethasone 10 mg), especially for malignancy
    • IV sedation (propofol 25-50 mcg/kg/min; midazolam 2-4 mg/hr, dexmedetomidine 0.2-0.4 mcg/kg/hr)
      • Impairs serial neuro exams (least with dexmedetomidine)
    • IV paralysis (rocuronium 0.6 mg/kg, cisatracurium 0.2 mg/kg)
      • Impairs serial neuro exams

Global strategy: the 8 Ds:

  • Detection (history & physical)
  • Data (CT, MRI, C-spine imaging, coags, lytes, ABG, CBC, drug levels)
  • Differential diagnosis
  • Decision
    • Drugs (mannitol, steroids, sedation/paralysis, antibiotics, vitamin K, plasma/platelets)
    • Drainage (craniotomy/burr hole, external ventricular drain [EVD])
    • Discontinue (terminal/irreversible disease, brain death)
    • Donate organs (brain death)

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Last updated: April 14, 2010

Citation

"CNS Mass Lesions." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534123/all/CNS_Mass_Lesions.
CNS Mass Lesions. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534123/all/CNS_Mass_Lesions. Accessed March 23, 2019.
CNS Mass Lesions. (2010). In Pocket ICU Management. Available from https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534123/all/CNS_Mass_Lesions
CNS Mass Lesions [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2019 March 23]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534123/all/CNS_Mass_Lesions.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - CNS Mass Lesions ID - 534123 Y1 - 2010/04/14/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534123/all/CNS_Mass_Lesions PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -