flower on an iconoclastic view of neuro-icu
DESCRIPTION
Oli Flower gives an iconoclastic view of neurocritical care. This is a talk that was given at the College of Intensive Care Medicine's ASM in Wellington in June 2013. It focuses on three aspects of traumatic brain injury management: - Prognostication - Transfusion thresholds - The role of ICP monitoringTRANSCRIPT
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NEUROCRITICAL CARE!
an iconoclastic view!
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smacc!GOLD
MARCH 2014!
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ICU RESEARCH!
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NEURO-ICU RESEARCH!
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Image: Nicolas de Camaret!
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Image: Nicolas de Camaret!
PaCO2!< 25!
THIO! CPP!>70! AEDs!
STEROIDS!
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Image: Tiago Vidal Dutra!
A STORY!
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Image: Jeremy Noble!
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Image: Geoffrey Fairchild!
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FUTILITY!
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GCS! >60!SHOCK!
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push on...!
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Hb 8.8!
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DO2 = [1.39 x Hb x SaO2 + (0.003 x PaO2)] x Q!
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Hb!
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RETROSPECTIVE!
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12.5-14!
LUND!
image by Kjell Eriksson!
fresh!
leukodepleted!
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photo by Dalibor Levicek!
Text BLOOD TRANSPLANT!
TRANSFUSION ASSAULT!
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MENON!
Le ROUX!
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9!9!9!
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CT!CODMAN!ICP 22!
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PARADIGM!
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ICP!image from the BBC!
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Randy!!Chesnut!
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BEST TRIP!LATIN AMERICA!324 PATIENTS!ICP vrs No ICP!
BEST!
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BEST!
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WORST!
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45%!
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55%!
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ICP!photo by Glatze mit Kamera
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logic!
image by yellowcloud!
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history!
image by sciencesque!
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In the beginning...!
SURGERY!
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SURGERY!ICP MONITORING!ICU!IMAGING!TRAUMA CARE!NOT DRY!The BTFG!
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evidence!
image by Robert Cudmore!
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RETROSPECTIVE!
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HOME!
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ICP!image from the BBC!
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it’s what you do with it!
it’s not the number!
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do research!
prognosticate with IMPACT!
transfuse if < 9 g/dL!
don’t rely on one number!