Category Archives: Neurology

What to do when there is no EBM?

Septic patients (Perel)

EBM de-emphasises intuition, unsystematic clinical experience & pathophysiological rationale as sufficient grounds for clinical decision making & stresses the examination of evidence from clinical research

No benefit to ARISE, PROCESS, PROMISE

Have multimodal approach to monitoring the CV system of septic patients

Solve therapeutic conflicts by choosing the least harmful option

Aim to de-escalate treatment as soon as possible and do not aim to normalise values

 

References:

Positive fluid balance in septic patients

A protocol-less approach to septic patient

 

The High Risk Surgical Patient (Zsolt)

References

EuSOS study

Pro-AQT study

OPTIMISE Study

Choice of monitoring device amongst anaesthetists

No benefits of SV optimisation in elective abdo surgery

 

Liver Failure (Wendon)

EASL Practical guidelines for the management of alcoholic liver disease

EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis

Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group

 

Subarachnoid Haemorrhage (Polderman)

Unsecured aneurysms rebleed 9-17% on day 0

Fever associated with poor outcomes

High incidence of CV dysfunction. Therefore would advocate CO monitoring

References

Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference.

 

NEXT Lounge: Experts discussion of Neuro Cases

Coma recovery score (revised) is used more prominently in the recovery literature which is validated in disorders of consciousness.

Carinal stimulation via suctioning rather than pain may be a more useful way of generating arousal.

Don’t say ‘squeeze my hands’ to assess commands – rather ‘give me (two) thumbs up’

Data from the IMPACT trials have been used to create a risk prediction model which is available online.

Prediction models for 6 month outcome after TBI

Alpha coma on EEG may have a poor prognosis but the cause is important to the outcome.

IMG_1550

Etiology, neurologic correlations, and prognosis in alpha coma

Medial temporal lobe seizures may not be well detected on surface EEG

American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology

Anti-N-methyl-D-aspartate receptor antibodies: A potentially treatable cause of encephalitis in the intensive care unit

Intensive Care for Neurosurgical Interventions

Should we admit elective neurosurgical patients to ICU?

Deciding on which patients to admit to ICU after neurosurgery depends upon pre-op comorbidity, intra-operative interventions and likely course post-operatively.

Traditional Concerns

  • Unexpected neuroworsening
    • Bleeding
    • Oedema
    • Seizures
  • Medical compilation related to procedure per se (e.g. diabetes insipidus)
  • Unrelated medical complications
  • Lack of awareness on the ward

Continue reading Intensive Care for Neurosurgical Interventions