When you don't have an ICP monitor on an acute SDH evacuation what to do?

Critical patients develop huge oedema after craniectomy from aSDH, there is the stepwise treatment explained by the AANS, but when you don't count with much of these steps, what to do!

You need to know that serum osmolarity <320 and Na < 160 at all times. One need to achieve cerebral perfusion, so target MBP(median blood pressure) no more that 110 at all times, SatO2 >90% at all times, are all good to follow!. But how to know when to do something radical when the Brain is being injured beyond return!. To check pupils diameter at all times, at least Q6H and to know the baseline (immediately post operative pupil's size) is a good thing to follow, and correlates this to the aforementioned signs is the most basic step to do (at least your patient is not going to die). If it is on the rise do something immediately!!!

There are state of the art ICU units, that count with ICP monitoring, oxigen level in brain tissue, so on and so forth, that could tell in real time the prognosis of the patient with certain probability and by so you could do real time procedures medically or surgically.

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