Ventricular Shunt Obstruction/Infection Clinical Pathway — Emergency, ICU and Inpatient
Ventricular Shunt Obstruction/Infection Clinical Pathway — Emergency, ICU and Inpatient
Concern for Shunt Malfunction
Critical ICP
- GCS < 8
- Cushing's Triad
- HTN
Bradycardia
Irregular respirations
- HTN
- Requiring Resuscitation Bay
Immediate
Neurosurgery Consult
Neurosurgery Consult
- Airway Management
- IV access, NPO, labs
- 3% Saline (5 mL/kg IV bolus)
- Consider Tapping Shunt
- Brain CT for Hydro
- Admit PICU or OR 4-5544
- Additional Medication Management
- Perioperative Care, Anesthesia/Sedation Pathway
High Risk
- Altered Mental Status
- Bradycardia
- Symptoms similar to prior obstructions
- Concerning imaging from OSH
Neurosurgery Notification
IV access, labs, NPO
Imaging Concerning for Shunt Malfunction
Assure IV access, labs, NPO
Neurosurgery Consult
Brain CT for Hydro
or formal reinterpretation of OSH imaging
or formal reinterpretation of OSH imaging
Moderate Risk
- Symptoms of possible shunt obstruction
- No clear diagnosis for symptoms
- Patient with multiple visits for the same symptoms
ED Evaluation and Treatment
Imaging Equivocal or Not
Indicating Shunt Malfunction
Indicating Shunt Malfunction
Neurosurgery Consult
Low Risk
- Symptoms much more likely
due to an alternative source - Baseline neurologic exam
ED Evaluation and Treatment
Admit PICU
Re-evaluation
Re-evaluation
Admit to Gen Peds/Adol
Re-evaluation
Re-evaluation
Discharge Criteria
Follow-up
Follow-up