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monitoring of the neurocriticall y ill patient in the emergency department scott weingart

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Page 1: Monitoring of the neurocritically ill patient in the emergency department scott weingart

monitoringof the neurocriticallyill patient in the emergency department

scottweingart

Page 2: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Sick HeadsDon’t Take

A Joke

Page 3: Monitoring of the neurocritically ill patient in the emergency department scott weingart

whoamI?

Page 4: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 5: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 6: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 7: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 8: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 9: Monitoring of the neurocritically ill patient in the emergency department scott weingart

What isthis talk based on?

Page 10: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Brain Trauma Foundation

Management and Prognosis ofSevere Traumatic Brain Injury

http://braintrauma.org

Page 11: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 12: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 13: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Neuro-Trauma

and other sick heads

Page 14: Monitoring of the neurocritically ill patient in the emergency department scott weingart

WhoAreYou?

Page 15: Monitoring of the neurocritically ill patient in the emergency department scott weingart

whereare

you?

Page 16: Monitoring of the neurocritically ill patient in the emergency department scott weingart

what’syour

motivation?

Page 17: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 18: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 19: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Sick HeadsDon’t Take

A Joke

Page 20: Monitoring of the neurocritically ill patient in the emergency department scott weingart

What’s funny in the ED?

Page 21: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Sick HeadsDon’t Take

A Joke

Page 22: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Sick Heads don’tAutoregulate

Page 23: Monitoring of the neurocritically ill patient in the emergency department scott weingart

SecondaryInjury

Page 24: Monitoring of the neurocritically ill patient in the emergency department scott weingart

SecondaryInjury =

OurFault

Page 25: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Monitoring

Page 26: Monitoring of the neurocritically ill patient in the emergency department scott weingart

1. Basic Monitoring2. Advanced Monitoring3. ICP Monitoring

Page 27: Monitoring of the neurocritically ill patient in the emergency department scott weingart

1. Things you Must Do2. Things you Should Do3. Things your pt needs like a hole in the head

Page 28: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 29: Monitoring of the neurocritically ill patient in the emergency department scott weingart

CPP=MAP-ICP

Page 30: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Non-InvasiveBlood Pressure

Page 31: Monitoring of the neurocritically ill patient in the emergency department scott weingart

SBP>90

MAP>90

Page 32: Monitoring of the neurocritically ill patient in the emergency department scott weingart

90-30=60

Page 33: Monitoring of the neurocritically ill patient in the emergency department scott weingart

PulseOx

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95-100%

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Sedation

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Page 37: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Little Things

Page 38: Monitoring of the neurocritically ill patient in the emergency department scott weingart

GlasgowComaScale

Page 39: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 40: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Sit ‘em up

Page 41: Monitoring of the neurocritically ill patient in the emergency department scott weingart

HOB @ 45°

Page 42: Monitoring of the neurocritically ill patient in the emergency department scott weingart

ETCO2

Page 43: Monitoring of the neurocritically ill patient in the emergency department scott weingart
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Page 45: Monitoring of the neurocritically ill patient in the emergency department scott weingart

ETCO2<35PaCO2 35-38

Page 46: Monitoring of the neurocritically ill patient in the emergency department scott weingart

C6H12O

6

Page 47: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Glucose 80-150

Page 48: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Na

Page 49: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Push Na to ~150Never <140

Page 50: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Na Cl mOsm/L

NS 154 154 308LR 130 109 273

Page 51: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Osm

Page 52: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Do not go beyond 320

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A-line

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Page 55: Monitoring of the neurocritically ill patient in the emergency department scott weingart

* Beat to Beat BP* Blood Sampling* Volume Status

Page 56: Monitoring of the neurocritically ill patient in the emergency department scott weingart

CVP

Page 57: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Urine Output

Page 58: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Keep Fluid Balance Positive

Page 59: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Temp

Page 60: Monitoring of the neurocritically ill patient in the emergency department scott weingart

<100° F

Page 61: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 62: Monitoring of the neurocritically ill patient in the emergency department scott weingart

O

In

Page 63: Monitoring of the neurocritically ill patient in the emergency department scott weingart

who needs it?

Page 64: Monitoring of the neurocritically ill patient in the emergency department scott weingart

•(GCS 3-8) with abnormal head CTs

•GCS (3-8) with normal CTs and two of the following:

•SBP<90•Posturing•Age>40

Page 65: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 66: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Camino

Page 67: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 68: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 69: Monitoring of the neurocritically ill patient in the emergency department scott weingart

IVC

Page 70: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 71: Monitoring of the neurocritically ill patient in the emergency department scott weingart

CPP=MAP-ICP

Page 72: Monitoring of the neurocritically ill patient in the emergency department scott weingart

ICP<20CPP>60

Page 73: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Compliance

Page 74: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Ocular Ultrasound

Page 75: Monitoring of the neurocritically ill patient in the emergency department scott weingart
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Page 77: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Review

Page 78: Monitoring of the neurocritically ill patient in the emergency department scott weingart

GCS

Page 79: Monitoring of the neurocritically ill patient in the emergency department scott weingart

MAP>90

Page 80: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Sat>95

Page 81: Monitoring of the neurocritically ill patient in the emergency department scott weingart

KeepSedated

Page 82: Monitoring of the neurocritically ill patient in the emergency department scott weingart

HOB at45°

Page 83: Monitoring of the neurocritically ill patient in the emergency department scott weingart

ETCO2 <35

Page 84: Monitoring of the neurocritically ill patient in the emergency department scott weingart

PCO2 35-38

Page 85: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Push Na to ~150Never <140

Page 86: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Glucose 80-150

Page 87: Monitoring of the neurocritically ill patient in the emergency department scott weingart

OSM < 320

Page 88: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Aline

Page 89: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Temp <100

Page 90: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Fluid Balance Postive

Page 91: Monitoring of the neurocritically ill patient in the emergency department scott weingart

ICP<20

Page 92: Monitoring of the neurocritically ill patient in the emergency department scott weingart

CPP>60

Page 93: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Not going to mess with a

non-compliant

head

Page 94: Monitoring of the neurocritically ill patient in the emergency department scott weingart
Page 95: Monitoring of the neurocritically ill patient in the emergency department scott weingart

Monitoring =Control

Page 96: Monitoring of the neurocritically ill patient in the emergency department scott weingart

“A fool with a tool is still

a fool”

Page 97: Monitoring of the neurocritically ill patient in the emergency department scott weingart

[email protected] www.emcrit.org

Page 98: Monitoring of the neurocritically ill patient in the emergency department scott weingart

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