CME Review ArticleEmergency Management of Increased Intracranial PressurePitfield, Alexander Fraser MD, FRCP(C); Carroll, Allison B. MD, FRCPC; Kissoon, Niranjan MD, FRCP(C), FAAP, FCCM, FACPE Author Information Staff Physician (Pitfield), Fellow (Carroll), Associate Head, Professor, and Vice President, Medical Affairs (Kissoon), Division of Critical Care, Department of Pediatrics, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada. All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity. Reprints: Niranjan Kissoon, MD, FRCP(C), FAAP, FCCM, FACPE, Division of Critical Care, Department of Pediatrics, British Columbia Children’s Hospital, The University of British Columbia, 4480 Oak St, Rm B245, Vancouver, British Columbia, Canada V6H 3V4 (e-mail: [email protected]). Pediatric Emergency Care: February 2012 - Volume 28 - Issue 2 - p 200-204 doi: 10.1097/PEC.0b013e318243fb72 Buy Metrics Abstract Primary neurological injury in children can be induced by diverse intrinsic and extrinsic factors including brain trauma, tumors, and intracranial infections. Regardless of etiology, increased intracranial pressure (ICP) as a result of the primary injury or delays in treatment may lead to secondary (preventable) brain injury. Therefore, early diagnosis and aggressive treatment of increased ICP is vital in preventing or limiting secondary brain injury in children with a neurological insult. Present management strategies to improve survival and neurological outcome focus on reducing ICP while optimizing cerebral perfusion and meeting cerebral metabolic demands. Targeted therapies for increased ICP must be considered and implemented as early as possible during and after the initial stabilization of the child. Thus, the emergency physician has a critical role to play in early identification and treatment of increased ICP. This article intends to identify those patients at risk of intracranial hypertension and present a framework for the emergency department investigation and treatment, in keeping with contemporary guidelines. Intensive care management and the treatment of refractory increases in ICP are also outlined. © 2012 Lippincott Williams & Wilkins, Inc.