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.Read More
TAMING THE NEURO ICU
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 .Read More
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.Read More
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.Read More
Pathophysiological (who rounds with me knowns is one of my fav words) processes triggered by the whole-body ischemia-reperfusion response that occurs during cardiac arrest and subsequent restoration of systemic circulation.
Why it matters ? Hypoxic Ischemic Encephalopathy ( HIE) is the overall endpoint result of the post- cardiac arrest syndrome .This topic is particularly relevant to neurointsvisits because 1) they can influence it by managing the post-cardiorespiratory arrest syndrome 2) they lead neuroprognostication.