CVC Confirmation using POCUS

CVC Confirmation using POCUS

Central venous catheters (CVCs) are widely used in the resuscitation and treatment of critically ill and injured patients. Standard practice necessitates verification of line placement when inserted above the diaphragm. This has traditionally been accomplished in most institutions by use of post-insertion chest radiography, which will both identify the tip of the catheter at the cavoatrial junction and rule out pneumothorax ipsilateral to the insertion site.

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Retained Hemothorax: An Unusual Case

Retained Hemothorax: An Unusual Case

Traumatic hemothorax occurs frequently, with up to 300,000 cases occurring yearly in the United States.1  In cases of polytrauma, head and chest injuries frequently occur together,2 and thus it is important for all neurointensivists who see TBI to understand management of common traumatic chest injuries, including hemothorax.  While some small hemothoraces (<300cc’s) can be monitored clinically,3 standard of care for most large traumatic hemothoraces is rapid tube thoracostomy. 

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Options for non-invasive ICP monitoring in patients with fulminant hepatic failure

Options for non-invasive ICP monitoring in patients with fulminant hepatic failure

Elevated intracranial pressure (ICP) is an important cause of death following acute liver failure (ALF). While invasive ICP monitoring (IICPM) is most accurate, the presence of coagulopathy increases bleeding risk in ALF. Our objective was to evaluate the accuracy of three noninvasive ultrasound-based measures for the detection of concurrent ICP elevation in ALF—optic nerve sheath diameter (ONSD) using optic nerve ultrasound (ONUS); middle cerebral artery pulsatility index (PI) on transcranial Doppler (TCD); and ICP calculated from TCD flow velocities (ICPtcd) using the estimated cerebral perfusion pressure (CPPe) technique .

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Precision Medicine in Neurocritical Care

Precision Medicine in Neurocritical Care

Precision medicine is “an innovative approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person” and has expanded from oncology to many other fields of medicine.1 Most clinical trials testing neurocritical care treatments have not been based on principles of precision medicine. Rather, they have used a “one-size-fits-all” approach. This has left us with largely neutral results regarding blood pressure (BP) management or surgical intervention for intracerebral hemorrhage, intracranial pressure (ICP) management in traumatic brain injury (TBI), and neuroprotection for ischemic stroke, TBI, and spinal cord injury.

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Delayed cerebral ischemia - Journal Club 10/18/18

Delayed cerebral ischemia - Journal Club 10/18/18

Delayed cerebral ischemia (DCI) is a major cause of morbidity and mortality from aneurysmal subarachnoid hemorrhage (aSAH), occurring in 30% of patients.1 Historically, symptomatic large artery vasospasm was thought the be the primary mechanism leading to DCI, but there is increasing evidence that many other processes contribute, including impaired cerebral autoregulation, cortical spreading depolarizations, and microvascular spasm and thrombosis.2 The early identification of patients at risk for DCI is an essential task for neurointensivists.

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