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Oli Flower gives an iconoclastic view of neurocritical care. This is a talk that was given at the College of Intensive Care Medicine's ASM in Wellington in June 2013. It focuses on three aspects of traumatic brain injury management: - Prognostication - Transfusion thresholds - The role of ICP monitoring
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NEUROCRITICAL CARE!
an iconoclastic view!
smacc!GOLD
MARCH 2014!
ICU RESEARCH!
NEURO-ICU RESEARCH!
Image: Nicolas de Camaret!
Image: Nicolas de Camaret!
PaCO2!< 25!
THIO! CPP!>70! AEDs!
STEROIDS!
Image: Tiago Vidal Dutra!
A STORY!
Image: Jeremy Noble!
Image: Geoffrey Fairchild!
FUTILITY!
GCS! >60!SHOCK!
push on...!
Hb 8.8!
DO2 = [1.39 x Hb x SaO2 + (0.003 x PaO2)] x Q!
Hb!
RETROSPECTIVE!
12.5-14!
LUND!
image by Kjell Eriksson!
fresh!
leukodepleted!
photo by Dalibor Levicek!
Text BLOOD TRANSPLANT!
TRANSFUSION ASSAULT!
MENON!
Le ROUX!
9!9!9!
CT!CODMAN!ICP 22!
PARADIGM!
ICP!image from the BBC!
Randy!!Chesnut!
BEST TRIP!LATIN AMERICA!324 PATIENTS!ICP vrs No ICP!
BEST!
BEST!
WORST!
45%!
55%!
ICP!photo by Glatze mit Kamera
logic!
image by yellowcloud!
history!
image by sciencesque!
In the beginning...!
SURGERY!
SURGERY!ICP MONITORING!ICU!IMAGING!TRAUMA CARE!NOT DRY!The BTFG!
evidence!
image by Robert Cudmore!
RETROSPECTIVE!
HOME!
ICP!image from the BBC!
it’s what you do with it!
it’s not the number!
do research!
prognosticate with IMPACT!
transfuse if < 9 g/dL!
don’t rely on one number!
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