Traumatic Brain Injury (Stocchetti)

GCS has its’ limitations on ICU

In traumatic head injuries, liaise with neurosurgical colleagues early

Repeat CT brain routinely 12-24 hours or sooner if concerns

 

References

Glasgow Coma Scale

ESICM Guide to assessing neurology of patients on ICU

ICP or not?

Prognostication post TBI in CRASH Trial

 

Brain death (Rothen)

The number of people waiting for organ transplant is increasing

Brain death pathophysiology

• Sympathetics storm
• Loss vasomotor control
• Loss respiratory control
• Endocrine changes; pituitary failure, thyroid failure, hyperglycaemia

Increased ICP -> early compensatory arterial hypertension (Cushing reflex) -> ‘sympathetic storm’ -> loss of vasomotor tone and peripheral vasodilatation

Protocolised care improves the management of organ donors

 

References

www.cobatrice.org

Management of potential organ donor

UK guide for diagnosis of brain death

Organ donor management targets

Protocolised care for organ donor: MONITOR Trial

 

Organ donation (Guttermsen)

Huge discrepancy in demand and organ donation

Types of donors

• Living donor
• Heart-beating, brain dead donor (BSD)
• Non-heart beating donor (DCD)

 

References

European report on organ transplants

Donation after circulatory death