monitoring of the neurocritically ill patient in the emergency department scott weingart
Sick Heads Don’t Take A Joke
who am I?
What is this talk based on?
Brain Trauma Foundation Management and Prognosis of Severe Traumatic Brain Injury
Neuro- Trauma and other sick heads
Who Are You?
where are you?
what’s your motivation?
Sick Heads Don’t Take A Joke
What’s funny in the ED?
Sick Heads Don’t Take A Joke
Sick Heads don’t Autoregulate
Secondary Injury
Secondary Injury = Our Fault
Monitoring
1. Basic Monitoring 2. Advanced Monitoring 3. ICP Monitoring
1. Things you Must Do 2. Things you Should Do 3. Things your pt needs like a hole in the head
CPP=MAP-ICP
Non-Invasive Blood Pressure
SBP>9 0 MAP>9 0
90-30 =60
Pulse Ox
%
Sedation
Little Things
Glasgow Coma Scale
Sit ‘em up
45 °
ETCO 2
ETCO2<35 PaCO
C 6 H 12 O 6
Glucose
NaNa
Push Na to ~150 Never <140
NaClmOsm/ L NS LR
Os m
Do not go beyond 320
A-line
* Beat to Beat BP * Blood Sampling * Volume Status
CV P
Urine Output
Keep Fluid Balance Positive
Tem p
<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 60
Compliance
Ocular Ultrasound
Review
GCS
MAP>9 0
Sat>95
Keep Sedated
HOB at 45 °
ETCO 2 <35
PCO
Push Na to ~150 Never <140
Glucose
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”
* Selected References are in your syllabus * All references at my web site * Presentation Style inspired by Lawrence Lessig