monitoringof the neurocriticallyill patient in the emergency department
scottweingart
Sick HeadsDon’t Take
A Joke
What isthis talk based on?
Brain Trauma Foundation
Management and Prognosis ofSevere Traumatic Brain Injury
http://braintrauma.org
Neuro-Trauma
and other sick heads
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 =
OurFault
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
Non-InvasiveBlood Pressure
ETCO2<35PaCO2 35-38
Push Na to ~150Never <140
Na Cl mOsm/L
NS 154 154 308LR 130 109 273
Do not go beyond 320
* Beat to Beat BP* Blood Sampling* Volume Status
Keep Fluid Balance Positive
•(GCS 3-8) with abnormal head CTs
•GCS (3-8) with normal CTs and two of the following:
•SBP<90•Posturing•Age>40
Ocular Ultrasound
Push Na to ~150Never <140
Fluid Balance Postive
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