Monitoring of the neurocritically ill patient in the emergency department scott weingart.

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