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Ventricular Shunt Obstruction/Infection — Concern for Shunt Malfunction — 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
  • Requiring Resuscitation Bay
Immediate
Neurosurgery Consult
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
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
Neurosurgery Consult
Low Risk
  • Symptoms much more likely
    due to an alternative source
  • Baseline neurologic exam
ED Evaluation and Treatment
Admit PICU
Re-evaluation
Admit to Gen Peds/Adol
Re-evaluation
Discharge Criteria
Follow-up
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