By M. Blaivas
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Sample text
Beside this optimizing oxygenation and blood pressure are needed and temperature, glucose, seizures, and other potential secondary brain insults management are essential. If GCS of the patients equal and below the 8, there are clinical symptoms like unilateral or bilaterally fixed and dilated pupils suggesting possible impending herniation from elevated ICP and/or decorticate or decerebrate posturing, bradycardia, hypertension, and respiratory depression progress, the treatment of head elevation, hyperventilation, and osmotic therapy (mannitol 1 g/kg iv) is planed urgently.
Their initial antibiotherapy may consist antipseudomonal cephalosporins (eg, cefepime, ceftazidime), antipseudomonal carbapenems (imipenem or meropenem), beta-lactam/beta-lactamase inhibitors (piperacillin-tazobactam) with an antipseudomonal fluoroquinolone (ciprofloxacin) or aminoglycoside plus linezolid or vancomycin (if risk factors for methicillin-resistant Staphylococcus aureus are present). If infection with Legionella pneumophila is suspected, the regimen should include a macrolide or fluoroquinolone rather than an aminoglycoside.
Fever is a complex adaptive response involving elaborate interactions between the immune and nervous systems. High temperatures inhibit growth of microorganisms, may reduce the expression of virulence factors, increase susceptibility to anti-microbials and enhance host immune responses. At the same time fever can worsen primary brain damage. Because increase in cerebral oxygen consumption may leads to increase in blood flow and accordingly in blood volume. This increase potentiates neurologic injury and causes brain edema.
