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Discussion

Quick Question???

This was not my patient and when I questioned the nurse I could not get a complete story due to time restraints. I have listed the scenario details 

Car vs tree accident. Pt was post laminectomy for surgical intervention for injury at thoracic site. Pt arrives to ICU with accordian drain and neck brace. No spinal precautions. Orders recieved to keep map greater than 85. Utilize levophed if required. I don't understand the permissive "hypertension". Why? Is this for perfusion of the injury site? 

ThAnks

 

 

 

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    Full disclosure: I'm not a trauma ICU nurse, just a bold CVICU nurse with some Neuro experience and exposure to trauma ICU.

    The easy answer is yes, it's probably to maintain perfusion of the injury site. I'm not sure of the exact mechanism in trauma/spinal patients, but in neuro patients who suffer an ischemic stroke (embolic or thrombotic) it's not uncommon to run SBP's higher (120-160 if I remember correctly, but it could be 140-180) to promote perfusion of the penumbra (area surrounding the site of injury). I imagine it's the same way for spinal cord injuries that are due to cord compression, but I'm not positive.

    I suppose another option could be to promote perfusion through the areas of swelling secondary to the laminectomy, but that seems less likely to me. Again, not a trauma ICU nurse, and very much open to correction if I'm wrong!

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    A MAP goal of > 85 is common for spinal cord injuries and yes it's to maintain perfusion to the penumbra and promote revascularization. These higher goals are associated with better outcomes. Same idea as for ischemic strokes, as otterpop pointing out. 

    I know it sounds crazy if you're not familiar with these patients. I had the same question when I first came to trauma.

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