Tips for Interpreting the CSF Opening Pressure

The normal range for CSF is reported differently in various sources, with most reporting a normal range of 7-18 cmH2O in adults, though some consider the normal range 5-25 cmH2O. However, a pressure >25 cmH2O or <5 cmH2O should certainly prompt you to look for a source.

 

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Burns Resuscitation

  • Signs of impending airway compromise include: stridor, wheezing, subjective dyspnea, and a hoarse voice.
  • Carbon monoxide (CO) poisoning may manifest with persistent neurologic symptoms or even as cardiac arrest.
  • Burns <15% TBSA generaly require only PO fluid resuscitation.
  • Do not include first degree burns in the calculation of % TBSA.
  • Generally crystalloid solutions should be infused during the initial 18-24 hrs of resuscitation. It is recommended that 5% dextrose be added to maintenance fluids for pediatric patients weighing < 20kg.
  • All resuscitation measures should be guided by perfusion pressure and urine output: Target a MAP of 60 mmHg, and urine output of 0.5-1.0ml/kg/hr for adults and 1-1.5mL/kg/h for pediatric patients.
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Compartment Syndrome

  1. Compartment syndrome is a life and limb threatening emergency that requires early recognition, prompt diagnosis and immediate management with fasciotomy
  2. While clinical evaluation is flawed, pain out of proportion to injury and pain with passive stretch of muscles within the compartment are the best screening tools.
  3. Do not wait for the development of pallor, absence of pulse or paralysis to consult surgery. These are late findings that may only arise once the limb is non-salvageable.
  4. In unconscious patients, there should be a low threshold to measure compartment pressure in patients who are at risk as clinical signs cannot be evaluated
  5. When measuring compartment pressures, look for an absolute pressure > 30 mm Hg and perfusion pressure (DBP – compartment pressure) of < 30 mm Hg. All patients with a clinical suspicion and normal pressures should have repeat pressures measured.

 

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Croup

Severity Management
Mild (score 0-1) Can be managed at home –  +/- dexamethasone 0.15mg/kg. Reassure parents and give advice on when to seek further medical attention.
Moderate croup (score 2-7) Do not distress child – +/- oxygen. Give 0.15mg/kg dexamethasone. Transfer for observation for 2-3 hours.
 Severe croup (score >8) Do not distress child – Give oxygen. Give 0.15mg/kg dexamethasone. If not improving give nebulised adrenaline 1:1,000 0.4ml/kg (max 5mls).  Admit to hospital

 

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