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Article of the Week

From Intracranial Pressure to Intracranial Dynamics

We’re all familiar with the Monro-Kellie hypothesis—the idea that the skull contains a fixed volume of brain tissue, blood, and cerebrospinal fluid. While this principle remains important, the authors of this article suggest that caring for patients with severe TBI today requires a more nuanced approach.

The article discusses the shift from focusing solely on intracranial pressure (ICP) to understanding overall intracranial dynamics, including how blood flow regulation and compartment pressures interact. By gaining a better understanding of cerebrovascular autoregulation issues and how various brain regions respond to injury, clinicians can develop more targeted treatment strategies. This evolving perspective is helping to refine neuromonitoring and ultimately improve care for critically injured patients.

Click the link to view the article or watch a short AI-generated article summary (6 min 09 sec).

Brasil S, Patriota GC, Godoy DA, Paranhos JL, Rubiano AM, Paiva WS. Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics. Crit Care. 2025;29(1):229.

Trauma Happenings

Dress For Success for Better Wound Healing

With over 5,000 products available in the U.S. market, many trauma nurses feel overwhelmed by the variety of wound dressings. Forget the old “wet-to-dry” dressings. Research shows that advanced dressings—such as hydrocolloids, foams, alginates, and hydrofibers—help retain moisture, promote faster healing, and reduce bacterial loads in wounds. 

Additionally, these dressings are often more cost-effective in terms of labor and patient comfort. To choose the most effective dressing, start with a thorough assessment of the patient and wound, then follow a wound dressing algorithm to ensure evidence-based, personalized care.

Read more in this informative review from American Nurse at the link below.

How Can I Prepare for my TCAR/PCAR Verification Exam?

From the TCAR Education Programs home page, click the Resources tab and then select Learner Resources. Here, you’ll find a Testing Tips document designed to help you succeed on the final exam. 

It includes practical strategies such as revisiting the Course Manual, reviewing the Summary of Key Points, retaking the Time To Review questions, and completing the optional Practice Test.

How Do You Say It? The Monro-Kellie Hypothesis

This medical phrase confuses almost everyone. What’s the correct terminology and spelling behind the concept underlying intracranial pressure? Is it Monro or Monroe? Kellie or Kelly? Doctrine, Theory, or Hypothesis? You’ve likely heard several versions.

The Monro-Kellie Hypothesis, as it was initially known, was drawn from the work of Alexander Monro and George Kellie, Scottish physicians of the late 18th and early 19th centuries, whose independent observations shaped our understanding of ICP. In the U.K., the terminology was clear—but confusion grew once the idea crossed the Atlantic.

Why? Most Americans learned about the Monroe Doctrine, which was President James Monroe’s 1823 warning to European powers to stay out of the Western Hemisphere. Unfortunately, the similar names have led to widespread mix-ups. No one will go to grammar prison for these slips, but you can elevate your medical credibility by using the correct term and spelling: the Monro-Kellie Hypothesis. Which makes sense, because science deals in theories, concepts, models, and hypotheses—not doctrines.

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