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monitoringof the neurocriticallyill patient in the emergency department
scottweingart
Sick HeadsDon’t Take
A Joke
whoamI?
What isthis talk based on?
Brain Trauma Foundation
Management and Prognosis ofSevere Traumatic Brain Injury
http://braintrauma.org
Neuro-Trauma
and other sick heads
WhoAreYou?
whereare
you?
what’syour
motivation?
Sick HeadsDon’t Take
A Joke
What’s funny in the ED?
Sick HeadsDon’t Take
A Joke
Sick Heads don’tAutoregulate
SecondaryInjury
SecondaryInjury =
OurFault
Monitoring
1. Basic Monitoring2. Advanced Monitoring3. ICP Monitoring
1. Things you Must Do2. Things you Should Do3. Things your pt needs like a hole in the head
CPP=MAP-ICP
Non-InvasiveBlood Pressure
SBP>90
MAP>90
90-30=60
PulseOx
95-100%
Sedation
Little Things
GlasgowComaScale
Sit ‘em up
HOB @ 45°
ETCO2
ETCO2<35PaCO2 35-38
C6H12O
6
Glucose 80-150
Na
Push Na to ~150Never <140
Na Cl mOsm/L
NS 154 154 308LR 130 109 273
Osm
Do not go beyond 320
A-line
* Beat to Beat BP* Blood Sampling* Volume Status
CVP
Urine Output
Keep Fluid Balance Positive
Temp
<100° F
O
In
who needs it?
•(GCS 3-8) with abnormal head CTs
•GCS (3-8) with normal CTs and two of the following:
•SBP<90•Posturing•Age>40
Camino
IVC
CPP=MAP-ICP
ICP<20CPP>60
Compliance
Ocular Ultrasound
Review
GCS
MAP>90
Sat>95
KeepSedated
HOB at45°
ETCO2 <35
PCO2 35-38
Push Na to ~150Never <140
Glucose 80-150
OSM < 320
Aline
Temp <100
Fluid Balance Postive
ICP<20
CPP>60
Not going to mess with a
non-compliant
head
Monitoring =Control
“A fool with a tool is still
a fool”
[email protected] www.emcrit.org
* Selected References are in your syllabus* All references at my web site* Presentation Style inspired by Lawrence Lessig
