ICP monitor

Indications
GCS 3-8 and abnormal CT
If normal CT, rate of elevated ICP is 10-15% so add:
GCS <8, Normal CT, and two of:
Age >40
SBP<90
Inability to monitor neuro status eg GA

Types
Gold standard is fluid coupled EVD (can also drain CSF, but can get blocked and be hard to place in high ICP where ventricles are small)
Intraparenchymal Bolt is a fibreoptic non fluid filled system

Bolt
Place on Right side (usually non dominant)
Mark Kochers point (2-3cm lateral to midline (approx mid pupillary line) and 1cm anterior to coronal suture
Need to make small incision in dura

Complications
3% major haemorrhage rate
Infection rises significantly after 5 days