Update on Guidelines for Traumatic Brain Injury

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Update on Guidelines for Traumatic Brain Injury"

Transcription

1 Update on Guidelines for Traumatic Brain Injury Current TBI Guidelines Shirley I. Stiver MD, PhD Department of Neurosurgery Guidelines for the management of traumatic brain injury Journal of Neurotrauma 24(S), May 2007 Impact of TBI Guidelines Impact of TBI Guidelines 277 trauma centers Routine ICP monitoring % % Ghajar Crit Care Med 23: 560 (1995) Hesdorffer J Trauma 52: 1202 (2002) Predictors of Guideline Compliance 1. Neurosurgical residency program (OR 5.0) 2. State / American College Surgeons Accreditation (OR 5.0) 3. Treatment protocols (OR 3.6) patients Pre-TBI Guidelines N = 37 Post-TBI Guidelines N = 56 GOS=1 Died GOS=2&3 Severe Disability GOS=4&5 Good Outcome 16(43%) 11(30%) 10 (27%) 9(16%) 8(14%) 39 (70%) Post- versus pre- : 9.1 times higher odds ratio of a good outcome Palmer et al J Trauma 50: (2001) Guidelines Central Concept Primary Injury Mechanical Vascular Secondary Injury Not all neurological damage from TBI occurs at the moment of impact New Classification I Must do II III Can do s of Evidence Standard Guideline Option Evidence Good quality RCT Moderate quality RCT Good quality cohort, case-control study Poor RCT Moderate/poor cohort, case-control Case series, Databases 1

2 Topic I II Blood pressure and oxygenation - Hyperosmolar therapy - Prophylactic hypothermia - - Infection prophylaxis - DVT prophylaxis - - Indications for ICP monitoring - ICP monitoring technology ICP thresholds - CPP thresholds - Brain oxygen monitoring and thresholds - - Anesthetics, analgesics, and sedatives - Nutrition - Anti-seizure prophylaxis - Hyperventilation - Steroids - - III Unchanged Guidelines I Must Do Steroids are NOT recommended for improving outcome or reducing ICP in patients with moderate or severe CRASH TBI Outcome High methylprednisolone is Dead associated with increased mortality and is contraindicated Steroid 1248 (26%) Placebo 1075 (22%) Crash Lancet 364: 1321 (2004); Lancet 365: 1957 (2005) Blood Pressure Avoid hypotension sbp < 90 mmhg Hyperventilation Prophylactic (PaCO2 < 25mmHg) not recommended ICP Monitoring Technology ICP Monitoring All severe TBI with GCS < 8 & abnormal CT Intracranial Pressure Thresholds Treat for ICP > 20 mmhg Pressure Volume Curve Ventricular catheter connected to external gauge is most accurate, low-cost & reliable Accuracy : 2mmHg in range 0-20mmHg 10% in range mmHg 2

3 Seizures Anticonvulsants recommended to decrease the incidence of early seizures, < 7days) (early seizures not associated with worse outcome) Prophylactic use of dilantin or valproate to prevent onset of Late post-traumatic seizures is NOT recommended Nutrition Feed beginning the first 72 hours to attain a full caloric replacement by post-injury day 7 I Can do Hypoxia Avoid PaO2 < 60mmHg or O2 sat< 90% Hyperventilation Temporizing measure for raised ICP Avoid first 24 hours after injury If used, augment with SjVO2 / PBrO2 Update TBI Guidelines Brain oxygen monitoring and thresholds Prophylactic Hypothermia Infection Prophylaxis Deep Vein thrombosis prophylaxis NEW Brain Oxygen Monitoring and Thresholds New Background ICP gives limited information about cerebral blood flow, oxygen delivery, metabolism Jugular venous saturation and brain tissue oxygen monitoring useful for detecting cerebral ischemia in patients with severe TBI Jugular venous saturation Brain oxygen tension (PBrO2) Treatment Threshold < 50% < 15 mmhg Prophylactic Hypothermia New Hypothermia slows cerebral metabolism ; 5-7% decrease in CMR02 for every C Control of intracranial hypertension Subgroup analysis duration, target temp, re-warm rate III can do Prophylactic hypothermia: NOT associated with decreased all cause mortality when compared with normothermic controls Lower risk of mortality if hypothermia maintained >48 hours (RR 0.51) Associated with higher GOS scores ; C Good outcome 3

4 Infection Prophylaxis New Background ICP monitoring infections as high as 27% CSF cultures 8% infection rate EVD catheter tips 14% infection rate Duration of monitoring > 5 days Other concurrent systemic infections Ivh or SAH Open skull fracture, basilar skull # with CSF leak Leakage around catheter Infection Prophylaxis New Prophylactic antibiotics Not recommended for ventricular catheter placement Routine catheter exchange offers no benefit Flushing of the ventricular catheter not recommended Bacitracin flushes : 18% infection rate vs 6% controls Aucoin Am J Med 80: 369 (1986) Infection Prophylaxis Preliminary Antibiotic impregnated catheters safe and effective 288 patients (37 TBI) minocycline & rifampin impregnated catheters Infection rate Colonization rate Impregnanted 1% 18% Nonimpregnanted 9% 37% Zambramski Neurosurgery 98: 725(2003) Deep Venous Thrombosis New Without prophylaxis, Incidence of DVT in severe TBI 20% Mechanical Prophylaxis Graduated compression stocking or intermittent pneumatic compression recommended until ambulatory Pharmacological Prophylaxis Low MW /unfractionated heparin in combination with mechanical prophylaxis ; risk of expansion of ICH Three Revised Topics Hyperosmolar therapy (previously Mannitol ) Anesthesia, analgesics, and sedatives (previously Barbiturates ) Cerebral Perfusion Thresholds Revised Hyperosmolar Therapy Revised Mannitol II Mannitol ( gm/kg) for ICP control ; avoid arterial hypotension Prior to ICP monitoring, Restrict mannitol use to patients with signs of impending cerebral herniation 4

5 Anesthetics, Analgesics, and Sedation Revised Propofol Infusion Syndrome II Should follow Propofol is recommended for ICP control, (but does not improve mortality or 6mo outcome) Barbiturates-prophylactic administration to induce burst suppression EEG is NOT recommended High-dose barbiturate administration recommended for ICP control, refractory to maximum medical and surgical therapy ; maintain hemodynamic stability Children, but also adults Clinical features: Hyperkalemia Hepatomegaly Lipemia Metabolic acidosis Myocardial failure Rhabdomyolysis Renal failure death Cerebral Perfusion Thresholds Revised Optimal CPP remains unanswered Cerebral Perfusion Thresholds II Should follow Avoid aggressive attempts to maintain CPP > 70 mmhg with fluids and pressors; increased risk of ARDS Geoffrey T. Manley, Chief of Neurotrauma SFGH, UCSF Kia Shahlaie, Neurosurgery, UC Davis 5

Moron General Hospital Ciego de Avila Cuba. Department of Neurological Surgery

Moron General Hospital Ciego de Avila Cuba. Department of Neurological Surgery Moron General Hospital Ciego de Avila Cuba Department of Neurological Surgery Early decompressive craniectomy in severe head injury with intracranial hypertension Angel J. Lacerda MD PhD, Daisy Abreu MD,

More information

Recent trends in the management of head injury

Recent trends in the management of head injury Recent trends in the management of head injury Contents: Current concepts of management in TBI Blood pressure and oxygenation Intracranial pressure monitoring Cerebral perfusion pressure Body temperature

More information

Pediatric Subdural Hematoma and Traumatic Brain Injury J. Charles Mace MD FACS Springfield Neurological Institute CoxHealth. Objectives 11/7/2017

Pediatric Subdural Hematoma and Traumatic Brain Injury J. Charles Mace MD FACS Springfield Neurological Institute CoxHealth. Objectives 11/7/2017 Pediatric Subdural Hematoma and Traumatic Brain Injury J. Charles Mace MD FACS Springfield Neurological Institute CoxHealth Objectives 1. Be able to discuss brain anatomy and physiology as it applies to

More information

Severe Head dinjury Management and Recent Advances

Severe Head dinjury Management and Recent Advances Severe Head dinjury ent and Recent Advances Presenter Dr Shejoy P Joshua Moderator Dr AK Mahapatra Dr Deepak Kumar Gupta 1 KEY Epidemiology Resuscitation Primary survey Secondary survey Neurological evaluation

More information

UAMS MEDICAL CENTER TRAUMA and CRITICAL CARE SERVICES MANUAL. SUPERSEDES: New PAGE: 1 of 5. RECOMMENDATION(S): Drs. Bill Beck/J.R.

UAMS MEDICAL CENTER TRAUMA and CRITICAL CARE SERVICES MANUAL. SUPERSEDES: New PAGE: 1 of 5. RECOMMENDATION(S): Drs. Bill Beck/J.R. SUPERSEDES: New PAGE: 1 of 5 Purpose: To provide recommendations for the treatment and management of patients with traumatic brain injury. Definitions: Severe TBI - Glasgow Coma Scale (GCS) of 3 to 8 without

More information

Shobana Rajan, M.D. Associate staff Anesthesiologist, Cleveland Clinic, Cleveland, Ohio

Shobana Rajan, M.D. Associate staff Anesthesiologist, Cleveland Clinic, Cleveland, Ohio Shobana Rajan, M.D. Associate staff Anesthesiologist, Cleveland Clinic, Cleveland, Ohio Shaheen Shaikh, M.D. Assistant Professor of Anesthesiology, University of Massachusetts Medical center, Worcester,

More information

Chapter 8: Cerebral protection Stephen Lo

Chapter 8: Cerebral protection Stephen Lo Chapter 8: Cerebral protection Stephen Lo Introduction There will be a variety of neurological pathologies that you will see within the intensive care. The purpose of this chapter is not to cover all neurological

More information

Brain under pressure Managing ICP. Giuseppe

Brain under pressure Managing ICP. Giuseppe Brain under pressure Managing ICP Giuseppe Citerio giuseppe.citerio@unimib.it @Dr_Cit Intro Thresholds Treating HICP Conclusions NO COI for this presentation Produces pressure gradients: herniation HIGH

More information

Traumatic Brain Injury

Traumatic Brain Injury Traumatic Brain Injury Mark J. Harris M.D. Associate Professor University of Utah Salt Lake City USA Overview In US HI responsible for 33% trauma deaths. Closed HI 80% Missile / Penetrating HI 20% Glasgow

More information

Medicines Protocol HYPERTONIC SALINE 5%

Medicines Protocol HYPERTONIC SALINE 5% Medicines Protocol HYPERTONIC SALINE 5% HYPERTONIC SALINE 5% v1.0 1/4 Protocol Details Version 1.0 Legal category POM Staff grades Registered Paramedic Registered Nurse Specialist Paramedic (Critical Care)

More information

Post Traumatic Epilepsy in Children

Post Traumatic Epilepsy in Children Post Traumatic Epilepsy in Children Javier Cardenas, MD Barrow Neurological Institute St Joseph s Hospital and Medical Center Director, B.R.A.I.N.S. Program Disclosure I have no financial relationship

More information

GLYCEMIC CONTROL IN NEUROCRITICAL CARE PATIENTS

GLYCEMIC CONTROL IN NEUROCRITICAL CARE PATIENTS GLYCEMIC CONTROL IN NEUROCRITICAL CARE PATIENTS David Zygun MD MSc FRCPC Professor and Director Division of Critical Care Medicine University of Alberta Zone Clinical Department Head Critical Care Medicine,

More information

Blood transfusions in sepsis, the elderly and patients with TBI

Blood transfusions in sepsis, the elderly and patients with TBI Blood transfusions in sepsis, the elderly and patients with TBI Shabbir Alekar MICU, CH Baragwanath Academic Hospital & The University of the Witwatersrand CCSSA Congress 11 June 2015 Packed RBC - complications

More information

PATHOPHYSIOLOGY OF ACUTE TRAUMATIC BRAIN INJURY. Dr Nick Taylor MBBS FACEM

PATHOPHYSIOLOGY OF ACUTE TRAUMATIC BRAIN INJURY. Dr Nick Taylor MBBS FACEM PATHOPHYSIOLOGY OF ACUTE TRAUMATIC BRAIN INJURY Dr Nick Taylor MBBS FACEM The Monro Kellie Doctrine CPP= MAP-ICP PRIMARY DAMAGE TBI is a heterogeneous disorder Brain damage results from external forces,

More information

Best-evidence Review of Acute Care for Moderate to Severe Traumatic Brain Injury

Best-evidence Review of Acute Care for Moderate to Severe Traumatic Brain Injury Pragmatic Evidence-based Review Best-evidence Review of Acute Care for Moderate to Severe Traumatic Brain Injury Reviewer Mark Ayson MBChB DPH Date Report Completed August 2011 Important Note: It is not

More information

The clinical evidence: Hypothermia for other indications

The clinical evidence: Hypothermia for other indications Sicily, October 18 TH 2006 The clinical evidence: Hypothermia for other indications K.H. Polderman, internist/intensivist University medical center Utrecht, The Netherlands That is why we need temperature

More information

Anesthetic Management of a Patient with Traumatic Brain Injury

Anesthetic Management of a Patient with Traumatic Brain Injury Anesthetic Management of a Patient with Traumatic Brain Injury Arne O. Budde, MD, DEAA Associate Professor of Anesthesiology Director, Division of Neuroanesthesia Department of Anesthesiology Milton S

More information

Controversies in Hemorrhagic Stroke Management. Sarah L. Livesay, DNP, RN, ACNP-BC, ACNS-BC Associate Professor Rush University

Controversies in Hemorrhagic Stroke Management. Sarah L. Livesay, DNP, RN, ACNP-BC, ACNS-BC Associate Professor Rush University Controversies in Hemorrhagic Stroke Management Sarah L. Livesay, DNP, RN, ACNP-BC, ACNS-BC Associate Professor Rush University Disclosures AHA/ASA Outline Blood pressure VTE Coagulopathy Early mobilization

More information

Capnography 101. James A Temple BA, NRP, CCP

Capnography 101. James A Temple BA, NRP, CCP Capnography 101 James A Temple BA, NRP, CCP Expected Outcomes 1. Gain a working knowledge of the physiology and science behind End-Tidal CO2. 2.Relate End-Tidal CO2 to ventilation, perfusion, and metabolism.

More information

In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine

In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine In-hospital Care of the Post-Cardiac Arrest Patient David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine Disclosures I have no financial interest, arrangement,

More information

11. Traumatic brain injury. Links between ICP, CPP, PRx monitoring and outcome after TBI. Does CT picture help in prediction of outcome?

11. Traumatic brain injury. Links between ICP, CPP, PRx monitoring and outcome after TBI. Does CT picture help in prediction of outcome? 11. Traumatic brain injury. Links between ICP, CPP, PRx monitoring and outcome after TBI. Does CT picture help in prediction of outcome? Critical levels of CPP, ICP and PRx Percentage of patients in outcome

More information

ANESTHETIZING DISEASED PATIENTS: URINARY; NEUROLOGICAL; TRAUMATIZED

ANESTHETIZING DISEASED PATIENTS: URINARY; NEUROLOGICAL; TRAUMATIZED ANESTHETIZING DISEASED PATIENTS: URINARY; NEUROLOGICAL; TRAUMATIZED Lyon Lee DVM PhD DACVA Patients with Urinary Tract Diseases General considerations Three main factors to consider in anesthetizing urinary

More information

The Lund Concept in 1999

The Lund Concept in 1999 The Lund Concept in 1999 Carl-Henrik Nordström, M.D., Ph.D. Department of Neurosurgery Lund University Hospital S-221 85 Lund Sweden A new therapeutic approach to reduce increased ICP, denoted the Lund

More information

ACS TQIP BEST PRACTICES IN THE MANAGEMENT OF TRAUMATIC BRAIN INJURY

ACS TQIP BEST PRACTICES IN THE MANAGEMENT OF TRAUMATIC BRAIN INJURY ACS TQIP BEST PRACTICES IN THE MANAGEMENT OF TRAUMATIC BRAIN INJURY Table of Contents Introduction... 3 Using the Glasgow Coma Scale... 3 Triage and Transport... 5 Goals of Treatment... 5 Intracranial

More information

Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure

Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure Introduction This pediatric respiratory failure guideline is a supplement to ELSO s General Guidelines for all

More information

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality

More information

Management of head injury in the intensive-care unit

Management of head injury in the intensive-care unit Management of head injury in the intensive-care unit Keith Girling Key points Head injuries are common and have a major impact predominantly on young individuals. Key principles of head-injury management

More information

Targeted Temperature Management: Normothermia for Neuroprotection

Targeted Temperature Management: Normothermia for Neuroprotection Targeted Temperature Management: Normothermia for Neuroprotection I. Rationale Elevated body temperature is associated with increased cerebral metabolic rate and associated metabolic demand, which can

More information

Early Pharmacologic Venous Thromboembolism (VTE) prophylaxis is NOT indicated in Traumatic Brain Injury

Early Pharmacologic Venous Thromboembolism (VTE) prophylaxis is NOT indicated in Traumatic Brain Injury Early Pharmacologic Venous Thromboembolism (VTE) prophylaxis is NOT indicated in Traumatic Brain Injury Nefertiti A. Brown, MD Morbidity & Mortality Conference SUNY Downstate Medical Center Department

More information

Mannitol versus Hypertonic Saline for Management of Elevated Intracranial Pressure Jerry Altshuler, PharmD; Diana Esaian, PharmD, BCPS

Mannitol versus Hypertonic Saline for Management of Elevated Intracranial Pressure Jerry Altshuler, PharmD; Diana Esaian, PharmD, BCPS Mannitol versus Hypertonic Saline for Management of Elevated Intracranial Pressure Jerry Altshuler, PharmD; Diana Esaian, PharmD, BCPS The intracranial compartment consists of predominantly brain parenchyma

More information

TITLE: Optimal Oxygen Saturation Range for Adults Suffering from Traumatic Brain Injury: A Review of Patient Benefit, Harms, and Guidelines

TITLE: Optimal Oxygen Saturation Range for Adults Suffering from Traumatic Brain Injury: A Review of Patient Benefit, Harms, and Guidelines TITLE: Optimal Oxygen Saturation Range for Adults Suffering from Traumatic Brain Injury: A Review of Patient Benefit, Harms, and Guidelines DATE: 11 April 2014 CONTEXT AND POLICY ISSUES Traumatic brain

More information

UPSTATE Comprehensive Stroke Center. Neurosurgical Interventions Satish Krishnamurthy MD, MCh

UPSTATE Comprehensive Stroke Center. Neurosurgical Interventions Satish Krishnamurthy MD, MCh UPSTATE Comprehensive Stroke Center Neurosurgical Interventions Satish Krishnamurthy MD, MCh Regional cerebral blood flow is important Some essential facts Neurons are obligatory glucose users Under anerobic

More information

Neurotrauma: The Place for Cooling

Neurotrauma: The Place for Cooling Neurotrauma: The Place for Cooling Cooling: to achieve hypothermia History, evidence, open questions Cooling: to achieve normothermia Evidence, open questions Cooling: Practical Aspects Hypothermia: History

More information

NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.

NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section. TITLE VENOUS THROMBOEMBOLISM PROPHYLAXIS SCOPE Provincial Acute and Sub-Acute Care Facilities APPROVAL AUTHORITY Alberta Health Services Executive Committee SPONSOR Vice President, Quality and Chief Medical

More information

Stroke Guidelines. November 19, 2011

Stroke Guidelines. November 19, 2011 Stroke Guidelines November 19, 2011 Clinical Practice Guidelines American Stroke Association Guidelines are comprehensive statements that provide the highest level of scientific evidence for clinical practice.

More information

Pharmacotherapy of traumatic brain injury

Pharmacotherapy of traumatic brain injury Submitted November 2015; Accepted December 2015 REVIEW W.M. van den Bergh Department of Intensive Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Correspondence

More information

PEEP recruitment maneuver

PEEP recruitment maneuver Robert M. Rodriguez, MD FAAEM Clinical Professor of Medicine and Emergency Medicine, UCSF Case 1: 40 yo Male restrained driver high speed MVA P 140, RR 40 labored, BP 100/70, O 2 sat 70 Chest wheeze, crackles

More information

Guideline Quick View: Venous Thromboembolism

Guideline Quick View: Venous Thromboembolism Guideline Quick View: Venous Thromboembolism The AORN Guideline Quick View is a key component of Guideline Essentials, a suite of online implementation tools designed to help the perioperative team translate

More information

Changes in Intracranial Pressure in Various Positions of the Head in Anaesthetised Patients

Changes in Intracranial Pressure in Various Positions of the Head in Anaesthetised Patients Bahrain Medical Bulletien, Vol. 25, No. 4, December 2003 Changes in Intracranial Pressure in Various Positions of the Head in Anaesthetised Patients Vinod K Grover, MD,MNAMS* Indu Bala, MD ** Someshwar

More information

NEONATAL HYPOXIC-ISCHAEMIC ENCEPHALOPATHY (HIE) & COOLING THERAPY

NEONATAL HYPOXIC-ISCHAEMIC ENCEPHALOPATHY (HIE) & COOLING THERAPY Background NEONATAL HYPOXIC-ISCHAEMIC ENCEPHALOPATHY (HIE) & COOLING THERAPY A perinatal hypoxic-ischaemic insult may present with varying degrees of neonatal encephalopathy, neurological disorder and

More information

Slide 1. Slide 2. Slide 3. Outline of This Presentation

Slide 1. Slide 2. Slide 3. Outline of This Presentation Slide 1 Current Approaches to Venous Thromboembolism Prevention in Orthopedic Patients Hujefa Vora, MD Maria Fox, RN June 9, 2017 Slide 2 Slide 3 Outline of This Presentation Pathophysiology of venous

More information

Surgery. Surgery Burr Hole. Surgery. Postoperative Intensive Care of the Neurosurgical Patient. Supratentorial Area. Infratentorial Area

Surgery. Surgery Burr Hole. Surgery. Postoperative Intensive Care of the Neurosurgical Patient. Supratentorial Area. Infratentorial Area Postoperative Intensive Care of the Neurosurgical Patient Supratentorial Area Above the tentorium (double fold of dura mater) Includes cerebral hemispheres Cynthia Bautista, PhD, RN, CNRN, SCRN, CCNS,

More information

Do Prognostic Models Matter in Neurocritical Care?

Do Prognostic Models Matter in Neurocritical Care? Do Prognostic Models Matter in Neurocritical Care? Alexis F. Turgeon MD MSc FRCPC Associate Professor and Director of Research Department of Anesthesiology and Critical Care Medicine Division of Critical

More information

EXPLOSIVE BLAST TRAUMATIC BRAIN INJURY

EXPLOSIVE BLAST TRAUMATIC BRAIN INJURY EXPLOSIVE BLAST TRAUMATIC BRAIN INJURY Geoffrey Ling, M.D., Ph.D. Colonel, Medical Corps, US Army Program Manager, DARPA Professor and Vice-Chair, Neurology, USUHS Director, Neuro Critical Care, WRAMC

More information

Anthony Sin, M.D. Department of Neurosurgery LSUHSC-S 1501 Kings Hwy Shreveport, LA

Anthony Sin, M.D. Department of Neurosurgery LSUHSC-S 1501 Kings Hwy Shreveport, LA Anthony Sin, M.D. Department of Neurosurgery LSUHSC-S 1501 Kings Hwy Shreveport, LA 71103 318-573-6906 318-675-6404 Education Emory University School of Medicine 1992-1996 Doctor of Medicine Johns Hopkins

More information

North Oaks Trauma Symposium Friday, November 3, 2017

North Oaks Trauma Symposium Friday, November 3, 2017 Traumatic Intracranial Hemorrhage Aaron C. Sigler, DO, MS Neurosurgery Tulane Neurosciences None Disclosures Overview Anatomy Epidural hematoma Subdural hematoma Cerebral contusions Outline Traumatic ICH

More information

Head Injury Management Guidelines For St Mary s Major Trauma Centre

Head Injury Management Guidelines For St Mary s Major Trauma Centre Head Injury Management Guidelines For St Mary s Major Trauma Centre Table of Contents Introduction... 2 Referral Process, Admission and Resuscitation... 2 The Trauma Tree Pathway:... 2 Neurosurgery Registrar

More information

Interventional treatment of Vascular Abnormalities

Interventional treatment of Vascular Abnormalities Interventional treatment of Vascular Abnormalities Edison P. Valle, M.D. Ochsner Neurosurgery. Comprehensive treatment of Neurovascular Abnormalities Disclosures Tools for treatment Open neuro-vascular

More information

Pressure reactivity: Relationship between ICP and arterial blood pressure (ABP). Pressure-reactivity index, computational methods. Clinical examples.

Pressure reactivity: Relationship between ICP and arterial blood pressure (ABP). Pressure-reactivity index, computational methods. Clinical examples. Pressure reactivity: Relationship between ICP and arterial blood pressure (ABP). Pressure-reactivity index, computational methods. Clinical examples. Optimization of cerebral perfusion pressure: Relationship

More information

PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT

PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT OBJECTIVE: To provide a diagnostic algorithm and treatment options for patients with acute pulmonary embolism (PE). BACKGROUND: Venous thromboembolism (VTE)

More information

Early Treatment of TBI A Prospective Study from Austria

Early Treatment of TBI A Prospective Study from Austria Early Treatment of TBI A Prospective Study from Austria Walter Mauritz MD, PhD Dept. of Anaesthesiology & Critical Care Trauma Hospital XX, 1200 Vienna, Austria International Neurotrauma Research Organisation,

More information

Neuroscience ICU: A Statewide Critical Care Resource

Neuroscience ICU: A Statewide Critical Care Resource Neuroscience ICU: A Statewide Critical Care Resource Ansgar M Brambrink, MD, PhD Director, Neuroscience Intensive Care Unit Oregon Health & Science University Portland, OR Neurocritical care in the US

More information

PEDIATRIC BRAIN CARE

PEDIATRIC BRAIN CARE PEDIATRIC BRAIN CARE The brain matters most! OVERVIEW OF NEURO ASSESSMENT 1. Overall responsiveness/activity 2. The eyes 3.? Increased ICP 4. Movements 5.? Seizures 6. Other OVERALL RESPONSIVENESS/ ACTIVITY

More information

Decompressive Hemicraniectomy in Acute Neurological Diseases

Decompressive Hemicraniectomy in Acute Neurological Diseases Decompressive Hemicraniectomy in Acute Neurological Diseases Angela Crudele, MD 1 ; Syed Omar Shah, MD 1 ; Barak Bar, MD 1,2 Department of Neurology, Thomas Jefferson University, Philadelphia, PA, Department

More information

Update in Critical Care Medicine

Update in Critical Care Medicine Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update

More information

Therapeutic Hypothermia after Resuscitated Cardiac Arrest

Therapeutic Hypothermia after Resuscitated Cardiac Arrest Therapeutic Hypothermia after Resuscitated Cardiac Arrest The purpose of this protocol is to improve the neurologic outcomes of patients who have experienced cardiac arrest and have been successfully resuscitated.

More information

ARDS & TBI - Trading Off Ventilation Targets

ARDS & TBI - Trading Off Ventilation Targets ARDS & TBI - Trading Off Ventilation Targets Salvatore M. Maggiore, MD, PhD Rome, Italy smmaggiore@rm.unicatt.it Conflict of interest Principal Investigator: RINO trial o Nasal high-flow vs Venturi mask

More information

Presentation & Management of Raised Intracranial Pressure. Professor of Neurosurgery

Presentation & Management of Raised Intracranial Pressure. Professor of Neurosurgery Presentation & Management of Raised Intracranial Pressure By Zain Alabedeen B. Jamjoom,, M.D. Professor of Neurosurgery Normal Intracranial Pressure Normal ICP ~10 mmhg (supine at the level of the foramen

More information

NEUROANESTHESIA QUIZ 2

NEUROANESTHESIA QUIZ 2 NEUROANESTHESIA QUIZ 2 Shobana Rajan, M.D. Attending Anesthesiologist, Albany Medical Center, Albany, NY Shaheen Shaikh, M.D. Assistant Professor of Anesthesiology, University of Massachusetts Medical

More information

Bedside microdialysis for early detection of cerebral hypoxia in traumatic brain injury

Bedside microdialysis for early detection of cerebral hypoxia in traumatic brain injury Neurosurg Focus 9 (5):E2, 2000 Bedside microdialysis for early detection of cerebral hypoxia in traumatic brain injury ASITA S. SARRAFZADEH, M.D., OLIVER W. SAKOWITZ, M.D., TIM A. CALLSEN, M.D., WOLFGANG

More information

Northwest Community EMS System - Continuing Education March 2015 Trauma QI Case Reviews - CE Credit Questions

Northwest Community EMS System - Continuing Education March 2015 Trauma QI Case Reviews - CE Credit Questions Name Employer Date Submitted Northwest Community EMS System - Continuing Education March 2015 Trauma QI Case Reviews - CE Credit Questions To receive credit for this CE module (Materials needed CE handout,

More information

Rounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center

Rounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center Rounds in the ICU Eran Segal, MD Director General ICU Sheba Medical Center Real Clinical cases (including our mistakes) Emphasis on hemodynamic monitoring Usually no single correct answer We will conduct

More information

Disclosures. Anesthesia for Endovascular Treatment of Acute Ischemic Stroke. Acute Ischemic Stroke. Acute Stroke = Medical Emergency!

Disclosures. Anesthesia for Endovascular Treatment of Acute Ischemic Stroke. Acute Ischemic Stroke. Acute Stroke = Medical Emergency! Disclosures Anesthesia for Endovascular Treatment of Acute Ischemic Stroke I have nothing to disclose. Chanhung Lee MD, PhD Associate Professor Anesthesia and perioperative Care Acute Ischemic Stroke 780,000

More information

Example Clinician Educational Material for Providers of Immune Effector Cellular Therapy

Example Clinician Educational Material for Providers of Immune Effector Cellular Therapy Example Clinician Educational Material for Providers of Immune Effector Cellular Therapy Disclaimer: This example is just one of many potential examples of clinician education material that can be provided

More information

Introduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring

Introduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring Introduction Invasive Hemodynamic Monitoring Audis Bethea, Pharm.D. Assistant Professor Therapeutics IV January 21, 2004 Hemodynamic monitoring is necessary to assess and manage shock Information obtained

More information

Neuromuscular Blockade in ARDS

Neuromuscular Blockade in ARDS Neuromuscular Blockade in ARDS Maureen O. Meade, MD, FRCPC Critical care consultant, Hamilton Health Sciences Professor of Medicine, McMaster University www.oscillatetrial.com Disclosures None Possible

More information

TREATMENT OF INTRACRANIAL ANEURYSMS

TREATMENT OF INTRACRANIAL ANEURYSMS TREATMENT OF INTRACRANIAL ANEURYSMS Presented by: Dr Nilesh S. Kurwale Introduction Incidence of aneurysm difficult to estimate Prevalence 0.2-7.9 % Half the aneurysms ruptures 2% present during childhood

More information

Time Equals Neurons - Spinal Cord Injury Management in the first 4 Hours

Time Equals Neurons - Spinal Cord Injury Management in the first 4 Hours Time Equals Neurons - Spinal Cord Injury Management in the first 4 Hours William D. Whetstone M.D. Clinical Professor UCSF Department of Emergency Medicine SFGH ED Center for Neuro-Critical Emergencies

More information

Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC

Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC Objectives 1. Define Hypoxic-Ischemic Encephalopathy (HIE) 2. Identify the criteria used to determine if an infant qualifies for therapeutic

More information

Neuro anesthesia quiz

Neuro anesthesia quiz Neuro anesthesia quiz Shobana Rajan, M.D. Attending Anesthesiologist, Albany Medical Center, Albany, NY Shaheen Shaikh, M.D. Assistant Professor of Anesthesiology, University of Massachusetts Medical center,

More information

Prevention of Venous Thromboembolism

Prevention of Venous Thromboembolism Prevention of Venous Thromboembolism Surgical Care Improvement Project Dale W. Bratzler, DO, MPH President and CEO Dale W. Bratzler, DO, MPH Oklahoma Foundation for Medical Quality QIOSC Medical Director

More information

WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE

WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE Subarachnoid Hemorrhage is a serious, life-threatening type of hemorrhagic stroke caused by bleeding into the space surrounding the brain,

More information

Case Scenario 3: Shock and Sepsis

Case Scenario 3: Shock and Sepsis Name: Molly Boyle 1. Define the term shock (Lewis textbook): Shock is a syndrome characterized by decreased perfusion and impaired metabolism. Shock can have a number of causes that result in damage to

More information

Monitoring of Cerebral and Spinal Haemodynamics during Neurosurgery

Monitoring of Cerebral and Spinal Haemodynamics during Neurosurgery Monitoring of Cerebral and Spinal Haemodynamics during Neurosurgery Bearbeitet von Georg E Cold, Niels Juul 1. Auflage 2008. Buch. XX, 332 S. Hardcover ISBN 978 3 540 77872 1 Format (B x L): 15,5 x 23,5

More information

Malignant Middle Cerebral Artery Infarction and Role of Decompressive Hemicraniectomy

Malignant Middle Cerebral Artery Infarction and Role of Decompressive Hemicraniectomy Malignant Middle Cerebral Artery Infarction and Role of Decompressive Hemicraniectomy Amrendra Miranpuri, MD Surgical Director, Comprehensive Stroke Center Objectives Natural history of malignant MCA infarction

More information

Traumatic brain injury: a review of pathophysiology and management

Traumatic brain injury: a review of pathophysiology and management Clinical Practice Review Journal of Veterinary Emergency and Critical Care 20(2) 2010, pp 177 190 doi:10.1111/j.1476-4431.2010.00527.x Traumatic brain injury: a review of pathophysiology and management

More information

Management of Spinal Cord Injury (in Critical Care by an Anaesthetist)

Management of Spinal Cord Injury (in Critical Care by an Anaesthetist) Management of Spinal Cord Injury (in Critical Care by an Anaesthetist) Dr Matt Wiles Consultant in Neuroanaesthesia & Neurocritical Care Sheffield Teaching Hospitals NHS Foundation Trust @STHJournalClub

More information

Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight

Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight Treatment of a Stroke patient: A look at how to care for the Stroke patient in the aeromedical setting Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight Objectives 1. Discuss the assessment

More information

Traumatic brain injury (TBI) remains a lethal injury. Marked reduction in mortality in patients with severe traumatic brain injury.

Traumatic brain injury (TBI) remains a lethal injury. Marked reduction in mortality in patients with severe traumatic brain injury. J Neurosurg 119:1583 1590, 2013 AANS, 2013 Marked reduction in mortality in patients with severe traumatic brain injury Clinical article Linda M. Gerber, Ph.D., 1 Ya-Lin Chiu, M.S., 1 Nancy Carney, Ph.D.,

More information

Nothing to Disclose. Severe Pulmonary Hypertension

Nothing to Disclose. Severe Pulmonary Hypertension Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis

More information

Disclosure. Seizure Prophylaxis in Traumatic Head Injury

Disclosure. Seizure Prophylaxis in Traumatic Head Injury Seizure Prophylaxis in Traumatic Head Injury Anthony Angelow, PhD(c), ACNPC, AGACNP-BC, CEN Associate Lecturer, Fitzgerald Health Education Associates Clinical practice Division of Trauma Surgery and Division

More information

Factors Contributing to Fatal Outcome of Traumatic Brain Injury: A Pilot Case Control Study

Factors Contributing to Fatal Outcome of Traumatic Brain Injury: A Pilot Case Control Study Factors Contributing to Fatal Outcome of Traumatic Brain Injury: A Pilot Case Control Study D. HENZLER, D. J. COOPER, K. MASON Intensive Care Department, The Alfred Hospital, Melbourne, VICTORIA ABSTRACT

More information

Raised Intracranial Pressure (ICP): Management in Emergency Department

Raised Intracranial Pressure (ICP): Management in Emergency Department Raised Intracranial Pressure (ICP): Management in Emergency Department Author: Dr. Shruti Sangani*, Dr. Samira Parikh** INTRODUCTION: Elevated intracranial pressure (ICP) is a potentially devastating complication

More information

YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL

YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL Administrative Policy Title: Brain Death, Guidelines Determination of Death by Neurological Criteria in the Pediatric Patient Manual

More information

Secondary brain damage accompanying increased intracranial pressure (TCP), which includes transtentorial herniation and cerebral ischemia, as well as

Secondary brain damage accompanying increased intracranial pressure (TCP), which includes transtentorial herniation and cerebral ischemia, as well as .-_--.-.--.--.--.. _-.-. -.--.--...-liliiii.-...-.... --- - -- -liliiii-...--.-... - --.,.".., Acta ;\1eurochir (1998) [Suppl] 71: 22-26 Springer-Verlag 1998 Comparative Effects of Hypothermia, Barbiturate,

More information

Clinical Practice Guideline for Patients Requiring Total Hip Replacement

Clinical Practice Guideline for Patients Requiring Total Hip Replacement Clinical Practice Guideline for Patients Requiring Total Hip Replacement Inclusions Patients undergoing elective total hip replacement Exclusions Patients with active local or systemic infection or medical

More information

INTRACRANIAL PRESSURE MONITORING

INTRACRANIAL PRESSURE MONITORING INTRACRANIAL PRESSURE MONITORING A Handbook for the Nursing Professional 2 Why do we care about measuring intracranial pressure (ICP)? The intracranial compartment is very different from other regions

More information

Phenytoin versus Levetiracetam for Prevention of Early Posttraumatic Seizures: A Prospective Comparative Study

Phenytoin versus Levetiracetam for Prevention of Early Posttraumatic Seizures: A Prospective Comparative Study 136 Original Article Phenytoin versus Levetiracetam for Prevention of Early Posttraumatic Seizures: A Prospective Comparative Study Kairav S. Shah 1 Jayun Shah 1 Ponraj K. Sundaram 1 1 Department of Neurosurgery,

More information

Every 15 Seconds, Someone In the United States Suffers a Traumatic Brain Injury

Every 15 Seconds, Someone In the United States Suffers a Traumatic Brain Injury Every 15 Seconds, Someone In the United States Suffers a Traumatic Brain Injury Background: Traumatic injury is the leading cause of death among persons between the ages of 1-44 years, accounting for 2.5

More information

Functional cerebral monitoring in patients with critically illness

Functional cerebral monitoring in patients with critically illness Functional cerebral monitoring in patients with critically illness Anne-Marie Guerguerian MD PhD Assistant Professor of Critical Care Medicine & Pediatrics Scientist in Neurosciences & Mental Health, Research

More information

Update sulle lesioni emorragiche posttraumatiche

Update sulle lesioni emorragiche posttraumatiche Update sulle lesioni emorragiche posttraumatiche Corrado Iaccarino Neurochirurgia-Neurotraumatologia AOU Parma Neurochirurgia d'urgenza IRCCS ASMN Reggio Emilia LAW UPDATING This document provides recommendations

More information