Severe traumatic brain injury. Fellowship Training Intensive Care Radboud University Nijmegen Medical Centre
|
|
- Godwin Houston
- 5 years ago
- Views:
Transcription
1 Severe traumatic brain injury Fellowship Training Intensive Care Radboud University Nijmegen Medical Centre
2 Primary focus of care Prevent ischemia, hypoxia and hypoglycemia Nutrient & oxygen supply Limited capacity for substrate storage High metabolic rate
3 Surrogates for brain ischemia and hypoxia GCS or FOUR score ICP Cerebral blood flow PbtO 2 Cerebral metabolism (microdialysis) EEG Biomarkers
4 Focal (subdural- and epidural hematoma, contusion) Diffuse (DAI) Combination Primary injury Catecholamine surge Systemic effects Depolarization and disturbance of ionic homeostasis Neurotransmitter release Apoptosis Lipid degradation Mitochondrial dysfunction Inflammatory and immune responses Dysautoregulation of brain vessels BBB disruption Organ dysfunction Hypoxia Hyperoxia Hypocapnia Hypercapnia Hyperthermia Hypotension ICP increase CPP decrease with ischemia Secondary injury
5 Primary Injury Secondary Injury Contusions Haematomas Diffuse injury ICP Ischaemia Receptor mediated Calcium damage mediated Inflammation damage Oxidative damage Secondary insults Hypoxia, Hyper- & Hypocapnia, Hypotension, Hyperthermia, Hyper- & hypoglycemia
6 Epidural hematoma Subdural hematoma Hemorrhagic contusion Diffuse axonal injury
7
8 Cerebral edema Minutes Immediately thereafter Hours Primary injury Cytotoxic edema Ionic edema Vasogenic edema = Cellular swelling = Extracellular swelling with intact BBB = Extracellular swelling with damaged BBB
9 Fluid compartments Brain Vasculature 100 ml CSF 100 ml Brain interstitial space 100 ml Intracellulair space 1.1 L Brain edema is an increase in the brain interstitial space Cerebral edema requires perfusion
10 ICP ICP > 20 mmhg is considered ICH - worse outcome Classic indications: GCS 3-8 with abnormal CT-scan GCS 3-8 with normal CT-scan and at least 2 of the following: age 40, unilateral or bilateral motor posturing, SBP < 90 mmhg
11 ICP monitoring Multicenter (N = 6) stratified RCT comparing ICT monitoring clinical examination/imaging Patients with TBI, aged > 13 and with a GCS 8 within 48 hours All patients had CT scan at 0 and 48 hrs and at 5-7 days Chesnut RM. N Engl J Med 2012;367:
12 N = ICP group Clinical group P = 0.49 P = 0.60 P = M Primary composite outcome 6 M Mortality (%) 6 M Favourable outcome (%) Pressure monitoring group received more barbiturates while clinical group received more hyperventilation and hypertonic saline Chesnut RM. N Engl J Med 2012;367:
13 Pressure and time burden of raised ICP Lower pressures with a longer duration also correlate with a bad outcome 6-M GOS) (red) In children lower pressure for a shorter amount of time have the same damage Güiza F. Intensive Care Med 2015;41:
14 Pressure and time burden of raised ICP Curve is shifted to the left if autoregulation (PRx) is absent (blue all patients, green normal autoregulation, red absent autoregulation) Güiza F. Intensive Care Med 2015;41:
15 Pressure and time burden of raised ICP CPP 50 mmhg CPP > 50 mmhg Güiza F. Intensive Care Med 2015;41:
16 Severe TBI For patients with age 65 the safe CPP zone is between CPP mmhg when autoregulation is active Deficient autoregulation reduces the tolerability for low CPP Episodes with ICP > 25 were associated with a worse outcome independent of CPP Güiza F. J Neurotrauma 2017
17
18 RescueICP trial Decompressive craniectomy for refractory ICP Hutchinson PJ. N Engl J Med 2016
19
20 Electrophysiological changes Cortical spreading depolarizations and nonconvullive seizures / periodic discharges Definite link between these electrophysiological changes and metabolic crises: L/P Microdialysis Tau levels correlate with MRI (DTI)- based measurements of reduced brain white matter integrity (sign of diffuse axonal injury)
21 Autoregulation - old and new Old New Slope 0.21 Slope 0.81 Buffering capacity against hypertension is certainly better
22 Bhatia A. Intensive Care Med 2007;33:
23 PRx
24 CPPOPT and PbrO2 CPPOPT range between and mm Hg Jaeger M. Crit Care Med 2010;38:
25 Global and regional CBF are nicely correlated Severe TBI, N = Regional CBF Regional (around triple-lumen bold) compared to 2 other regions of interest (supraventricular white matter supplied by ACM and ACA) Global CBF Bouzat P. Crit Care Med 2015;43:
26 Prediction of low CBF by multimodal monitoring < 35 ml/100g/min ROC variable AUC 95% CI ICP ICP + CMD ICP + PbtO ICP + PbtO2 + CMD Bouzat P. Crit Care Med 2015;43:
27 Paroxysmal sympathetic hyperactivity Fever Hypertension Tachycardia Tachypnea Diaphoresis Dystonic posturing Incidence: 15-33% in severe TBI From 24 hrs to weeks after TBI Differential diagnosis Sepsis Seizures Hydrocephalus / intracranial hypertension Agitation, pain, central fever, withdrawal
28 Pathophysiology Excitatory-Inhibitory model Inhibitory centers brainstem diencephalon Afferent stimuli Sympathetic output +++
29
30 Cardiac effects of severe TBI Overall 20% of als severe TBI patients show early systolic dysfunction within first week (risk factors lower age and lower admission GCS) Krishnamoorthy V. Crit Care Med 2017
31 Hyponatremia CSW SIADH BNP Inhibits: sympathetic outflow RAAS vasoconstrictor peptides Normal renal function No volume expansion Normal adrenal function Inappropriate sodium loss High Una, high urine output, hypotension, low CVP Correction of volume depletion Hypertonic saline Fludrocortisone ADH Inappropriate water retention Lower Una, lower urine output, normotension, normal CVP Fluid restriction
32 Acute spinal cord trauma Combination of fractured and retropulsed bone fragments, disk herniation and subluxation of vertebral bodies (sometimes spinal epidural hematoma) Overall 20% affect more than 1 level Cervical spine especially vulnerable
33 Symptoms Relatively symmetric paralysis of the limbs Urinary retention or incontinence Localized pain and sensory level In acute phase hyperreflexia and Babinski often absent Systemic hypotension
34 Classification - prognosis
35 Central cord syndrome (Typically cervical spine from trauma) Weakness and reflex loss in arms (less in legs) Reduced pain and thermal sense in arms often with hyperesthesia (vibration and proprioception often normal) Variable hyperreflexia in legs
36
37
38 Treatment No corticosteroids Immediate treatment of hypotension with fluid and NE to maintain a MAP of mmhg (1 week) Surgical decompression and stabilization within 24 hrs (complications: infection, hardware failure, pseudoarthrosis, degenerative changes at adjacent spinal levels)
PACT module. Traumatic Brain Injury. Intensive Care Training Program Radboud University Medical Centre Nijmegen
PACT module Traumatic Brain Injury Intensive Care Training Program Radboud University Medical Centre Nijmegen Severe traumatic brain injury Leading cause of morbidity/mortality among young individuals
More informationPRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8
PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain
More informationCase 1. Case 5/30/2013. Traumatic Brain Injury : Review, Update, and Controversies
Case 1 Traumatic Brain Injury : Review, Update, and Controversies Shirley I. Stiver MD, PhD 32 year old male s/p high speed MVA Difficult extrication Intubated at scene Case BP 75 systolic / palp GCS 3
More informationTraumatic 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 informationTraumatic Brain Injuries
Traumatic Brain Injuries Scott P. Sherry, MS, PA-C, FCCM Assistant Professor Department of Surgery Division of Trauma, Critical Care and Acute Care Surgery DISCLOSURES Nothing to disclose Discussion of
More informationImproving TBI outcome
Improving TBI outcome Dr Peter Smielewski ps10011@cam.ac.uk 20/10/2017 Division of Neurosurgery, Department of Clinical Neurosciences Background Stein, S. C., Georgoff, P., et al. (2010). Journal of Neurotrauma
More informationWhat is elevated ICP?
What is elevated ICP? and When should it be treated? David Menon Professor of Anaesthesia, University of Cambridge ICP monitoring recommended to reduce inhospital & 2-wk mortality Rx ICP > 22 mm Hg as
More informationPerioperative Management of Traumatic Brain Injury. C. Werner
Perioperative Management of Traumatic Brain Injury C. Werner Perioperative Management of TBI Pathophysiology Monitoring Oxygenation CPP Fluid Management Glycemic Control Temperature Management Surgical
More informationINTRACRANIAL PRESSURE -!!
INTRACRANIAL PRESSURE - Significance raised ICP main cause of death in severe head injury main cause of morbidity in moderate and mild head injury main target and prognostic indicator in the ITU setting
More informationStandardize comprehensive care of the patient with severe traumatic brain injury
Trauma Center Practice Management Guideline Iowa Methodist Medical Center Des Moines Management of Patients with Severe Traumatic Brain Injury (GCS < 9) ADULT Practice Management Guideline Contact: Trauma
More informationAny closer to evidence based practice? Asma Salloo Chris Hani Baragwantah Academic Hospital University of Witwatersrand
Any closer to evidence based practice? Asma Salloo Chris Hani Baragwantah Academic Hospital University of Witwatersrand Evidence Pathophysiology Why? Management Non-degenerative, Non-congenital insult
More information8/29/2011. Brain Injury Incidence: 200/100,000. Prehospital Brain Injury Mortality Incidence: 20/100,000
Traumatic Brain Injury Almario G. Jabson MD Section Of Neurosurgery Asian Hospital And Medical Center Brain Injury Incidence: 200/100,000 Prehospital Brain Injury Mortality Incidence: 20/100,000 Hospital
More informationTraumatic Brain Injury:
Traumatic Brain Injury: Changes in Management Across the Spectrum of Age and Time Omaha 2018 Trauma Symposium June 15, 2018 Gail T. Tominaga, M.D., F.A.C.S. Scripps Memorial Hospital La Jolla Outline Background
More informationPATHOPHYSIOLOGY 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 information11/27/2017. Stroke Management in the Neurocritical Care Unit. Conflict of interest. Karel Fuentes MD Medical Director of Neurocritical Care
Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Conflict of interest None Introduction Reperfusion therapy remains the mainstay in the treatment
More informationPositron Emission Tomography Imaging in Brain Injured Patients
Positron Emission Tomography Imaging in Brain Injured Patients Paul Vespa, MD Professor Director of Neurocritical Care UCLA Brain Injury Research Center Outline Clinical Context of imaging Practical issues
More informationPediatric 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 informationPediatric Head Trauma August 2016
PEDIATRIC HEAD TRAUMA AUGUST 2016 Pediatric Head Trauma August 2016 EDUCATION COMMITTEE PEER EDUCATION Quick Review of Pathophysiology of TBI Nuggets of knowledge to keep in mind with TBI Intracranial
More informationStroke & Neurovascular Center of New Jersey. Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center
Stroke & Neurovascular Center of New Jersey Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center Past, present and future Past, present and future Cerebral Blood Flow Past, present and future
More informationState of the Art Multimodal Monitoring
State of the Art Multimodal Monitoring Baptist Neurological Institute Mohamad Chmayssani, MD Disclosures I have no financial relationships to disclose with makers of the products here discussed. Outline
More informationNeurocritical Care Monitoring. Academic Half Day Critical Care Fellows
Neurocritical Care Monitoring Academic Half Day Critical Care Fellows Clinical Scenarios for CNS monitoring No Universally accepted Guidelines Traumatic Brain Injury Intracerebral Hemorrhage Subarachnoid
More informationBrain 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 informationHead injuries. Severity of head injuries
Head injuries ED Teaching day 23 rd October Severity of head injuries Minor GCS 14-15 Must not have any of the following: Amnesia 10min Neurological sign or symptom Skull fracture (clinically or radiologically)
More informationTraumatic brain injuries are caused by external mechanical forces such as: - Falls - Transport-related accidents - Assault
PP2231 Brain injury Cerebrum consists of frontal, parietal, occipital and temporal lobes Diencephalon consists of thalamus, hypothalamus Cerbellum Brain stem consists of midbrain, pons, medulla Central
More informationMedical Management of Intracranial Hypertension. Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center
Medical Management of Intracranial Hypertension Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center Anatomic and Physiologic Principles Intracranial compartments Brain 80% (1,400
More informationICP. A Stepwise Approach. Stephan A. Mayer, MD Professor, Neurology & Neurosurgery Director, Neurocritical Care, Mount Sinai Health System
ICP A Stepwise Approach Stephan A. Mayer, MD Professor, Neurology & Neurosurgery Director, Neurocritical Care, Mount Sinai Health System ICP: Basic Concepts Monroe-Kellie doctrine: skull = fixed volume
More informationCEREBRAL DECONGESTANTS. Dr. Dwarakanath Srinivas Additional Professor Neurosurgery, NIMHANS
CEREBRAL DECONGESTANTS Dr. Dwarakanath Srinivas Additional Professor Neurosurgery, NIMHANS Cerebral Oedema Increase in brain water content above normal (80%) in response to primary brain insult. Intracranial
More informationR Adams Cowley Founder of the R Adams Cowley Shock Trauma Center and Maryland EMS System in Baltimore, Maryland.
R Adams Cowley 1917 -- 1991 Founder of the R Adams Cowley Shock Trauma Center and Maryland EMS System in Baltimore, Maryland. ...That the primary purpose of medicine was to save lives, that every critically
More informationUpdate on Guidelines for Traumatic Brain Injury
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
More information11/23/2015. Disclosures. Stroke Management in the Neurocritical Care Unit. Karel Fuentes MD Medical Director of Neurocritical Care.
Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Disclosures I have no relevant commercial relationships to disclose, and my presentations will not
More informationCOMA & INTENSIVE CARE
COMA & INTENSIVE CARE Jozef Firment, MD. PhD., Judita Capkova, MD. PhD. Department of Anaesthesiology & Intensive Care Medicine Šafárik University Faculty of Medicine, Košice Coma Is a state of unarousable
More informationINCREASED INTRACRANIAL PRESSURE
INCREASED INTRACRANIAL PRESSURE Sheba Medical Center, Acute Medicine Department Irene Frantzis P-Year student SGUL 2013 Normal Values Normal intracranial volume: 1700 ml Volume of brain: 1200-1400 ml CSF:
More informationAnesthetic 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 informationSpinal Cord Injury Transection Injury, Spinal Shock, and Hermiated Disc. Copyright 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc.
Spinal Cord Injury Transection Injury, Spinal Shock, and Hermiated Disc 1 Spinal Cord Injury Results from fracture and/or dislocation of vertebrae // Compresses, stretches, or tears spinal cord Cervical
More informationH Alex Choi, MD MSc Assistant Professor of Neurology and Neurosurgery The University of Texas Health Science Center Mischer Neuroscience Institute
H Alex Choi, MD MSc Assistant Professor of Neurology and Neurosurgery The University of Texas Health Science Center Mischer Neuroscience Institute Memorial Hermann- Texas Medical Center Learning Objectives
More informationCNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationNeuroprotective Effects for TBI. Craig Williamson, MD
Neuroprotective Effects for TBI Craig Williamson, MD Neuroprotection in Traumatic Brain Injury Craig Williamson Clinical Assistant Professor Neurocritical Care Fellowship Director Disclosures I will discuss
More informationPre-hospital Response to Trauma and Brain Injury. Hans Notenboom, M.D. Asst. Medical Director Sacred Heart Medical Center
Pre-hospital Response to Trauma and Brain Injury Hans Notenboom, M.D. Asst. Medical Director Sacred Heart Medical Center Traumatic Brain Injury is Common 235,000 Americans hospitalized for non-fatal TBI
More informationHead Trauma Inservice (October)
John Tramell - Head Trauma Inservice, October 2005.doc Page 1 Head Trauma Inservice (October) Head trauma is the leading cause of death in trauma patients. Having a basic understanding of the anatomy and
More informationProceedings of the Southern European Veterinary Conference - SEVC -
www.ivis.org Proceedings of the Southern European Veterinary Conference - SEVC - Sep. 29-Oct. 2, 2011, Barcelona, Spain Next SEVC Conference: Oct. 18-21, 2012 - Barcelona, Spain Reprinted in the IVIS website
More informationNeurointensive Care of Aneurysmal Subarachnoid Hemorrhage. Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA
Neurointensive Care of Aneurysmal Subarachnoid Hemorrhage Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA The traditional view: asah is a bad disease Pre-hospital mortality
More informationDecompressive craniectomy following traumatic brain injury
Decompressive craniectomy following traumatic brain injury Peter Hutchinson Division of Academic Neurosurgery University of Cambridge Escalating cycle of brain swelling Primary insult Brain swelling Secondary
More information9/19/2011. Damien Beilman, RRT Adult Clinical Specialist Wesley Medical Center. Epidural Hematoma: Lens Shaped.
Damien Beilman, RRT Adult Clinical Specialist Wesley Medical Center Epidural Hematoma: Lens Shaped. 1 Epidural Hematoma Subdural Hematoma: Crescent-shaped Subdural Hematoma 2 Cerebral Contusion Cause of
More informationMichael Avant, M.D. The Children s Hospital of GHS
Michael Avant, M.D. The Children s Hospital of GHS OVERVIEW ER to ICU Transition Early Management Priorities the First 48 hours Organ System Support Complications THE FIRST 48 HOURS Communication Damage
More informationHEAD INJURY. Dept Neurosurgery
HEAD INJURY Dept Neurosurgery INTRODUCTION PATHOPHYSIOLOGY CLINICAL CLASSIFICATION MANAGEMENT - INVESTIGATIONS - TREATMENT INTRODUCTION Most head injuries are due to an impact between the head and another
More informationPediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University
Pediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University SHOCK Definition: Shock is a syndrome = inability to provide sufficient oxygenated blood to tissues. Oxygen
More informationContinuous cerebral autoregulation monitoring
Continuous cerebral autoregulation monitoring Dr Peter Smielewski ps10011@cam.ac.uk 20/10/2017 Division of Neurosurgery, Department of Clinical Neurosciences Determinants of cerebral blood flow Thanks
More informationRecent 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 informationCrackCast Episode 8 Brain Resuscitation
CrackCast Episode 8 Brain Resuscitation Episode Overview: 1) Describe 6 therapeutic interventions for the post-arrest brain 2) List 5 techniques for initiating therapeutic hypothermia 3) List 4 mechanisms
More informationOptimum sodium levels in children with brain injury. Professor Sunit Singhi, Head, Department of Pediatrics, Head, Pediatric
India Optimum sodium levels in children with brain injury Professor Sunit Singhi, Head, Department of Pediatrics, Head, Pediatric Sodium and brain Sodium - the major extracellular cation and most important
More informationIndex. Note: Page numbers of article titles are in bold face type.
Neurosurg Clin N Am 13 (2002) 259 264 Index Note: Page numbers of article titles are in bold face type. A Abdominal injuries, in child abuse, 150, 159 Abrasions, in child abuse, 157 Abuse, child. See Child
More informationTraumatic Brain Injury
General Information Traumatic Brain Injury What you need to know Complicated condition with high variability in etiology, severity, distribution of injury, and pattern of functional impairment (Klyce,
More informationDo 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 informationDisclosure Statement. Dr. Kadish has no relevant financial relationships with any commercial interests mentioned in this talk.
Disclosure Statement Dr. Kadish has no relevant financial relationships with any commercial interests mentioned in this talk. Head Trauma Evaluation Primary and secondary injury Disposition Sports related
More informationNeurophysiology Lecture One : Neurophysiology and Evoked Potentials Lecture Two: Clinical Neuroanesthesia
Neurophysiology Lecture One : Neurophysiology and Evoked Potentials Lecture Two: Clinical Neuroanesthesia Reza Gorji, MD University Hospital September 2007 Topics Covered Today Intracranial Pressure Intracranial
More information9/16/2018. Recognizing & Managing Seizures in Pediatric TBI. Objectives. Definitions and Epidemiology
Recognizing & Managing Seizures in Pediatric TBI UW Medicine EMS & Trauma 2018 Conference September 17 and 18, 2018 Mark Wainwright MD PhD Herman and Faye Sarkowsky Professor of Neurology Division Head,
More informationMultimodal monitoring to individualize care in TBI
Multimodal monitoring to individualize care in TBI Critical Care Canada Forum 2017 October 4 th, 2017 Donald Griesdale MD MPH Associate Professor Department of Anesthesiology, Pharmacology & Therapeutics
More informationIntroduction to Neurosurgical Subspecialties:
Introduction to Neurosurgical Subspecialties: Trauma and Critical Care Neurosurgery Brian L. Hoh, MD 1, Gregory J. Zipfel, MD 2 and Stacey Q. Wolfe, MD 3 1 University of Florida, 2 Washington University,
More informationOrganic Mental Disorders. Organic Mental Disorders. Axes. Damrongsak Bulyalert Department of Internal Medicine
Organic Mental Disorders Damrongsak Bulyalert Department of Internal Medicine www.metadon.net 1 Organic Mental Disorders In DSM (Diagnostic and Statistical Manual of Mental Disorders), OMD includes Delirium,
More informationPERSPECTIVE INJURY SEVERITY. REHABILITATION PHYSICIAN Team approach Functional implications Long term consequences
MANAGEMENT OF INDIVIDUALS STATUS POST BRAIN INJURY: IMPACT ON LIFE CARE PLANNING Richard Bonfiglio, M.D. PERSPECTIVE REHABILITATION PHYSICIAN Team approach Functional implications Long term consequences
More informationCNS pathology Third year medical students,2019. Dr Heyam Awad Lecture 2: Disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students,2019 Dr Heyam Awad Lecture 2: Disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationMoron 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 informationMannitol 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 informationPediatric Head Injury:
Pediatric Head Injury: Part I Basic Principles Jogi V. Pattisapu, MD FAAP FACS Emeritus Medical Director Arnold Palmer Medical Center College of Medicine University of Central Florida Orlando FL USA JogiP@mail.UCF.edu
More informationSupplementary Online Content
Supplementary Online Content Cooper DJ, Nichol A, Bailey M, et al. Effect of early sustained prophylactic hypothermia on neurologic outcomes among patients with severe traumatic brain injury: the POLAR
More informationChapter 57: Nursing Management: Acute Intracranial Problems
Chapter 57: Nursing Management: Acute Intracranial Problems NORMAL INTRACRANIAL PRESSURE Intracranial pressure (ICP) is the hydrostatic force measured in the brain CSF compartment. Normal ICP is the total
More informationBest-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 informationLisa T. Hannegan, MS, CNS, ACNP. Department of Neurological Surgery University of California, San Francisco
Lisa T. Hannegan, MS, CNS, ACNP Department of Neurological Surgery University of California, San Francisco Era of Clinical Neuro Monitoring Clinical Examination Heart rate Blood Pressure Body temperature
More information11. 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 informationIatrogenic Central Diabetes Insipidus Induced by Vasopressin Withdrawal
Open Journal of Clinical & Medical Case Reports Volume 1 (2015) Issue 7 Abstract ISSN 2379-1039 Iatrogenic Central Diabetes Insipidus Induced by Vasopressin Withdrawal * Joseph R Shiber, MD ; Donald Johnson,
More informationEvaluation & Management of Elevated Intracranial Pressure in Adults. Dr. Tawfiq Almezeiny
Evaluation & Management of Elevated Intracranial Pressure in Adults Dr. Tawfiq Almezeiny Objectives Pathophsiology of elevated intracranial pressure. Clinical features and sequences. Management : Investigations
More informationLOSS OF CONSCIOUSNESS & ASSESSMENT. Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT
LOSS OF CONSCIOUSNESS & ASSESSMENT Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT OUTLINE Causes Head Injury Clinical Features Complications Rapid Assessment Glasgow Coma Scale Classification
More informationCardio Pulmonary Cerebral Resuscitation
Cardio Pulmonary Cerebral Resuscitation Brain Under Pressure October 3, 2017 Canadian Critical Care Forum Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto
More informationSHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
More informationMalignant Edema and Hemicraniectomy After Stroke
Malignant Edema and Hemicraniectomy After Stroke Sherri A. Braksick, MD March 29, 2017 No Financial Disclosures No Discussion of Off-Label Usage Objectives 1. Review the pathophysiology of edema after
More information8th Annual NKY TBI Conference 3/28/2014
Closed Head Injury: Headache to Herniation A N T H O N Y T. K R A M E R U N I V E R S I T Y O F C I N C I N N A T I B L U E A S H E M S T E C H N O L O G Y P R O G R A M Objectives Describe the pathological
More informationManagement of Traumatic Brain Injury (and other neurosurgical emergencies)
Management of Traumatic Brain Injury (and other neurosurgical emergencies) Laurel Moore, M.D. University of Michigan 22 nd Annual Review February 7, 2019 Greetings from Michigan! Objectives for Today s
More informationBlood Brain Barrier (BBB)
Cerebral Blood Flow, Cerebral Spinal Fluid, and Brain Metabolism Part Two Guyton Chapter 61 Morgan & Mikhail, 4 th ed, Chapter 25 (or Morgan & Mikhail 5 th ed, Chapter 26) Blood Brain Barrier (BBB) Cerebral
More informationCPPopt: matters to be solved before or by an RCT? Geert Meyfroidt, MD, PhD Intensive Care Medicine University Hospitals Leuven Belgium
CPPopt: matters to be solved before or by an RCT? Geert Meyfroidt, MD, PhD Intensive Care Medicine University Hospitals Leuven Belgium Financial disclosures Research Foundation, Flanders (senior clinical
More informationKlinikum Frankfurt Höchst
Blood pressure management in hemorrhagic stroke Blood pressure in acute ICH Do we need additional trials after INTERACT2 and ATTACH-II? Focus.de Department of Neurology,, Germany Department of Neurology,
More informationANESTHETIZING 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 informationPressure 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 informationBRAIN TRAUMA THERAPEUTIC RECOMMENDATIONS
1 BRAIN TRAUMA THERAPEUTIC RECOMMENDATIONS Richard A. LeCouteur, BVSc, PhD, Dip ACVIM (Neurology), Dip ECVN Professor Emeritus, University of California, Davis, California, USA Definitions Hemorrhage:
More informationTHE ESSENTIAL BRAIN INJURY GUIDE
THE ESSENTIAL BRAIN INJURY GUIDE Neuroanatomy & Neuroplasticity Section 2 Contributors Erin D. Bigler, PhD Michael R. Hoane, PhD Stephanie Kolakowsky-Hayner, PhD, CBIST, FACRM Dorothy A. Kozlowski, PhD
More informationTBI are twice as common in males High potential for poor outcome Deaths occur at three points in time after injury
Head Injury Any trauma to (closed vs. open) Skull Scalp Brain Traumatic brain injury (TBI) High incidence Most common causes Falls Motor vehicle accidents Other causes Firearm- related injuries Assaults
More informationChapter 31. Objectives. Objectives 01/09/2013. Head Trauma
Chapter 31 Head Trauma Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced
More informationCosa chiedo alla PtO 2
Cosa chiedo alla PtO 2 Pr Mauro Oddo Department of Medical-Surgical Intensive Care Medicine CHUV-Lausanne University Hospital Faculty of Biology and Medicine, University of Lausanne, Switzerland NEURO
More informationTraumatic Brain Injury Pathways for Adult ED Patients Being Admitted to Trauma Service
tic Brain Injury Pathways for Adult ED Patients Being Admitted to Service Revision Team Tyler W. Barrett, MD, MSCI Elizabeth S. Compton, NP Bradley M. Dennis, MD Oscar D. Guillamondegui, MD, MPH Michael
More informationUPSTATE 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 informationPediatric Trauma Initial Evaluation and management
Pediatric Trauma Initial Evaluation and management Head Injury Closed head injury Penetrating head injury Closed Head Injury without Fractures Head injury is the most common cause of death and disability
More information10/6/2017. Notice. Traumatic Brain Injury & Head Trauma
Notice All EMS Live@Nite presentations will be recorded (both audio and video) and available for public viewing online. By participating in EMS Live@Nite, you consent to audio and video recording and its/their
More informationRenal Regulation of Sodium and Volume. Dr. Dave Johnson Associate Professor Dept. Physiology UNECOM
Renal Regulation of Sodium and Volume Dr. Dave Johnson Associate Professor Dept. Physiology UNECOM Maintaining Volume Plasma water and sodium (Na + ) are regulated independently - you are already familiar
More informationsecondary effects and sequelae of head trauma.
Neuroimaging of vascular/secondary secondary effects and sequelae of head trauma. Andrès Server Alonso Department of Neuroradiology Division of Radiology Ullevål University Hospital Oslo, Norway. Guidelines
More informationHYPERBARIC OXYGEN BRAIN INJURY TREATMENT TRIAL: A MULTICENTER PHASE II ADAPTIVE CLINICAL TRIAL
HYPERBARIC OXYGEN BRAIN INJURY TREATMENT TRIAL: A MULTICENTER PHASE II ADAPTIVE CLINICAL TRIAL Gaylan Rockswold, MD, PhD, Principal Investigator William Barsan, MD, Principal Investigator, CCC, SIREN Byron
More informationAlterations of Neurologic Function
Pathophysiology JP Advis DVM, Ph.D. Bartlett Hall, Animal Sciences, Cook, 932-9240, advis@aesop.rutgers.edu 08 Course website: rci.rutgers.edu/~advis Lectures, tests, grades, office hours, textbook, Material
More informationTHREE HUNDRED AND ten TBI patients with a
Acute Medicine & Surgery 2014; 1: 31 36 doi: 10.1002/ams2.5 Original Article Outcome prediction model for severe traumatic brain injury Jiro Iba, 1 Osamu Tasaki, 2 Tomohito Hirao, 2 Tomoyoshi Mohri, 3
More informationTraumatic Brain Injury TBI Presented by Bill Masten
1 2 Cerebrum two hemispheres and four lobes. Cerebellum (little brain) coordinates the back and forth ballet of motion. It judges the timing of every movement precisely. Brainstem coordinates the bodies
More information11 th Annual Cerebrovascular Symposium 5/11-12/2017. Hypertonic Use D E R E K C L A R K
Hypertonic Use D E R E K C L A R K 1 Outline Types of hyperosmolar therapy Review Cerebral Na Physiology Differences between periphery and BBB Acute phase Subacute phase Chronic changes Hypertonic Saline
More informationPlenary Address: Medico-Legal Issues in Neuro-intensive Care
Plenary Address: Medico-Legal Issues in Neuro-intensive Care Dr Basil Matta Divisional Director, Emergency and Perioperative Care Cambridge University Hospitals NHS Foundation Trust Medico-Legal Issues
More informationChapter 39 Trauma in the Elderly
Chapter 39 Trauma in the Elderly Episode Overview 1) 5 Risk Factors for falls in the elderly? 2) What anatomic and physiologic changes in the elderly patient are important for the management of trauma
More information