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Neurocritical Care,  An Issue of Critical Care Clinics, E-Book

Neurocritical Care, An Issue of Critical Care Clinics, E-Book

Cherylee W.J. Chang

(2014)

Abstract

This issue of Critical Care Clinics focuses on Neurocritical Care and covers topics such as: The Evolution of Neurocritical Care, Update in management of acute ischemic stroke, Intracerebral hemorrhage, Subarachnoid treatment, Intracranial pressure monitoring and management of intracranial hypertension, Status Epilepticus, Brain Resuscitation and Prognosis after Cardiac Arrest, Neuromuscular complications of Critical Illness, Adverse Neurological Effects of Commonly Used ICU medications, and Brain death and management of a potential organ donor.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Neurocritical Care\r i
Copyright\r ii
Contributors iii
Contents v
Critical Care Clinics\r viii
Preface\r ix
Erratum xi
The Evolution of Neurocritical Care 657
Key points 657
Historical aspects 657
Mechanical ventilation and the birth of critical care medicine 658
Head trauma 659
Intracranial pressure 660
Neuromonitoring 662
Brain death 663
Cardiopulmonary resuscitation and hypothermia for cardiac arrest 664
Future direction 665
Summary 666
References 666
Update in the Management of Acute Ischemic Stroke 673
Key points 673
Introduction 673
Initial 24 hours for patients eligible for thrombolytic therapy 674
Intravenous Thrombolytics 675
Antiplatelets and Anticoagulants 675
Blood Pressure Management 675
Early Imaging 679
Other Testing 681
Endovascular Management 681
Dysphagia Screening 684
Initial 24 hours for patients ineligible for thrombolytic therapy 684
Pharmacologic Strategies 684
Antiplatelet agents 684
Anticoagulants/Antithrombotic agents 685
BP management 685
Deep venous thrombosis prophylaxis 685
Temperature 685
Blood glucose control 686
Gastrointestinal prophylaxis 686
Hydration and fluid status 686
Nonpharmacologic Strategies 686
Cardiac monitoring 686
Management of acute ischemic stroke beyond the initial 24 hours 687
Pharmacologic Strategies 687
BP management 687
General management 687
Mixed Pharmacologic and Nonpharmacological Strategies 687
Airway management and mechanical ventilation 687
Acute neurologic worsening 688
Cerebral edema 688
Seizures 689
Surgical options 689
Endarterectomy 689
Decompressive craniectomy and external ventricular drain insertion 690
Hemorrhagic transformation 690
Summary 691
References 691
Critical Care Management of Intracerebral Hemorrhage 699
Key points 699
Introduction 700
Pathogenesis 700
Diagnosis 701
Acute management 704
ABCs 704
Blood Pressure 705
Coagulopathy 705
Neurocritical Care 706
Repeat Imaging 706
Ventriculostomy and ICP Management 706
Surgical Interventions 707
Seizure Monitoring and Anticonvulsant Treatment 707
Cardiac Monitoring 708
Mechanical Ventilation 708
Nutrition 708
Hyperglycemia, Hypothermia 709
Infection 709
Venous Thromboembolism Prophylaxis 709
Blood Transfusion 709
Outcome Predictions 709
Long-term management 710
Summary 711
References 711
Treatment of Subarachnoid Hemorrhage 719
Key points 719
Introduction 719
Patient evaluation 720
Initial Stabilization 720
Diagnosis 721
SAH 721
Identification of Bleeding Source 721
Clinical Grading Scales 722
Treatment of the aneurysm 722
Complications 722
Seizures 722
Rebleeding 723
Hydrocephalus 723
Cardiac 723
Fever 724
Hyponatremia 724
Vasospasm and DCI 724
DCI prophylaxis: euvolemia 725
DCI prophylaxis: calcium channel blockers 726
DCI prophylaxis: lumbar drains 726
Diagnosing Vasospasm and DCI 726
TCD 726
CTA, CT perfusion, and angiography 727
DCI Management: Hemodynamic Augmentation 727
Induced hypertension 727
Augmenting cardiac output 727
Hemoglobin 727
DCI Management: Intra-arterial Treatment 728
Prognosis 728
Summary 728
References 728
Intracranial Pressure Monitoring and Management of Intracranial Hypertension 735
Key points 735
Introduction 735
Methods of ICP monitoring 736
Normal and pathologic ICP 737
ICP: more than a number 738
Controversies of ICP monitoring 739
Management of ICH 741
General Measures 741
CSF Drainage 743
Osmotherapy 743
Decompressive Craniectomy 744
Barbiturate Coma 745
Hypothermia 745
Summary 745
References 746
Neurocritical Care 751
Key points 751
Introduction 751
Epidemiology 752
Diagnosis and clinical presentation 752
Differential diagnosis 752
Diagnostic work-up 752
Acute management of SE 754
Prehospital treatment 754
Initial in-hospital/emergency department treatment 754
Secondary in-hospital treatment 755
Advanced management of RSE 756
Midazolam 756
Propofol 758
Barbiturates 758
Ketamine 759
Treatment endpoints 759
Complications 760
Neurology 760
Cardiac 761
Pulmonary 761
Infectious Disease 761
Electrolytes 761
Renal 761
Prognosis 761
References 762
Brain Resuscitation and Prognosis After Cardiac Arrest 765
Key points 765
Introduction 765
Epidemiology and impact 766
Pathophysiology of brain injury after cardiac arrest 766
Prehospital stabilization and evaluation of cardiac arrest 767
Angiography and coronary intervention 768
Oxygenation and ventilation 768
Blood pressure management 769
Glycemic control 769
Targeted temperature management 769
Hypothermia After Cardiac Arrest clinical trial 770
Australian hypothermia clinical trial 770
Target Temperature Management clinical trial 771
Sedation and shivering during targeted temperature management 772
Neuromonitoring after cardiac arrest: clinical examination 772
ICP Monitoring 772
Electroencephalogram Monitoring and Seizure Detection 773
Prognostication after cardiac arrest: clinical examination 773
Utility of SSEP in Prognostication 774
Utility of EEG in Prognostication 775
Utility of Brain Imaging in Prognostication 777
Effect of induced hypothermia on prognostic markers 778
Summary 779
References 780
Neuromuscular Complications of Critical Illness 785
Key points 785
Background 785
Approach to acute neuromuscular weakness in the ICU 786
CIP 787
Electrophysiology 787
Differential Diagnosis 788
Pathophysiology 788
Treatment 789
Prognosis 789
CIM 789
Thick Filament Myosin Loss 790
Rhabdomyolysis 791
Cachectic Myopathy 791
Acute Necrotizing Myopathy 791
Pathophysiology 791
Treatment 792
Summary 792
References 792
Adverse Neurologic Effects of Medications Commonly Used in the Intensive Care Unit 795
Key points 795
Introduction 795
Neurologic complications from medication discontinuation 796
Drug-induced seizures 797
Drugs Associated with Seizures 798
Mechanisms of Drug-Induced Seizures 800
Drug-induced psychosis/delirium 802
Drug-induced increased intracranial pressure 803
Drug-induced fever 804
Treatment 807
Rechallenge 807
Summary 807
References 807
Brain Death and Management of a Potential Organ Donor in the Intensive Care Unit 813
Key points 813
Introduction 813
Brain death criteria 816
Practice Before the American Academy of Neurology Guidelines 816
The American Academy of Neurology Guidelines (1995 and the 2010 Update) 817
Practice Variability in Brain Death Determination 817
Common Pitfalls in Determination 819
Ancillary Testing 820
Documentation 821
Management of potential organ donor 821
Identification of Potential Organ Donors and Organ Procurement Organizations 821
Preparation for Organ Procurement 823
Pathophysiologic Changes After Brain Death and Medical Management 823
Temperature Management 824
Cardiovascular/Hemodynamics Management 824
Pulmonary/Ventilator Management 826
Hormonal/Inflammatory Management 826
The family meeting 826
Summary 828
References 828
Index 833