CNS Mass Lesions
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 November 22, 2024.
CNS Mass Lesions. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. 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 2024 November 22]. 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 -