ICU sharing (SAH) by Jengshing Ngoi

Aneurysmal Subarachnoid hemorrhage: Clinical manifestation and diagnosis

jengshingngoi — 2022-08-04 13:12:00 UTC

Aneurysmal subarachnoid hemorrhage: Treatment and prognosis

jengshingngoi — 2022-08-04 13:14:38 UTC

Aneurysmal subarachnoid hemorrhage: Epidemiology, risk factors, and pathogenesis

jengshingngoi — 2022-08-04 13:16:30 UTC

Subarachnoid hemorrhage grading scales

jengshingngoi — 2022-08-04 13:18:51 UTC

Treatment of cerebral aneurysms

jengshingngoi — 2022-08-04 13:19:43 UTC

Vasospasm, Cushing triads. Drugs used for vasospasm.

ashleyyeosm — 2022-08-08 07:30:49 UTC

EVD Management (EVD insertion, Difference between EVD and ICP. EVD challenge. VP shunt)

ashleyyeosm — 2022-08-08 07:32:38 UTC

Pathophysiology of aneurysmal Subarachnoid haemorrhage (SAH)

ashleyyeosm — 2022-08-08 07:33:55 UTC

Definition of Aneurysmal SAH. Types and common location of aneurysm. Risk Factors and Signs and symptoms.

ashleyyeosm — 2022-08-08 07:36:36 UTC

Medical and Nursing management of High ICP: Mannitol, 3% Saline, Atracurium and BIS&TOF. Ventilator and temperature management.

ashleyyeosm — 2022-08-08 07:39:22 UTC

Explain about barbiturate coma

ashleyyeosm — 2022-08-08 07:40:04 UTC

SAH grading scale and prognosis. Diagnostic (CTB, CTA)

ashleyyeosm — 2022-08-08 07:40:49 UTC

DI vs SIADH

ashleyyeosm — 2022-08-08 07:42:05 UTC

Surgical and Nursing management of SAH. (4VA, coiling, clipping, craniotomy, craniectomy)

ashleyyeosm — 2022-08-08 07:43:01 UTC

yonehmee — 2022-08-22 11:23:18 UTC

DI vs SIADH

lixiaodan0723 — 2022-08-22 14:50:41 UTC

EVD Management

2022-08-23 05:00:50 UTC

DI

2022-08-23 07:18:16 UTC

Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms:
Central (neurogenic, pituitary, or neurohypophyseal).
DI is characterized by decreased secretion of antidiuretic hormone.

Nephrogenic DI is characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney.

The most common form is central DI after trauma or surgery to the region of the pituitary and hypothalamus, which may exhibit 1 of the following 3 patterns:
Transient
Permanent
Triphasic

2022-08-23 10:02:34 UTC

Indication :

-Potentially survivable head injury

-No surgically treatable lesion accounting for intracranial hypertension

-Other conventional therapies of controlling ICP have failed

– Posture
– Hyperventilation
– osmotic and tubular diuretics
corticosteroids

-ICP > 20 to 25 mmHg for more than 20 min or >40 mmHg at any time

-unilateral cerebral hemispheric edema with significant shift (> 0.7 mm) of midline structures shown on CT

-gcs drop or low score

maychiew92 — 2022-08-23 10:38:58 UTC

Cerebral Vasospasm

2022-08-23 11:25:06 UTC

Vasospasm is defined as focal or diffuse temporarily narrowed vessel caliber due to contraction of smooth muscle in the wall of arteries. It is detected by angiography or imaging studies (transcranial dopper [TCD], magnetic resonance [MR], and CT) or as seen during surgical clipping.
Vasospasm occurs in 67% of aSAH patients, is symptomatic in 30% to 40%, and results in ischemic infarction in 10% to 45% of patients.

Management of Cerebral Vasospasm and DCI After aSAH: Recommendations

2022-08-23 12:11:44 UTC

Oral nimodipine should be administered to all patients with aSAH (Class I; Level of Evidence A). (It should be noted that this agent has been shown to improve neurological outcomes but not cerebral vasospasm. The value of other calcium antagonists, whether administered orally or intravenously, remains uncertain.)

Maintenance of euvolemia and normal circulating blood volume is recommended to prevent DCI (Class I; Level of Evidence B).

Prophylactic hypervolemia or balloon angioplasty before the development of angiographic spasm is NOT RECOMMENDED (Class III; Level of Evidence B).

Transcranial Doppler is reasonable to monitor for the development of arterial vasospasm (Class IIa; Level of Evidence B). (New recommendation)

Perfusion imaging with CT or magnetic resonance can be useful to identify regions of potential brain ischemia (Class IIa; Level of Evidence B).

Induction of hypertension is recommended for patients with DCI unless blood pressure is elevated at baseline or cardiac status precludes it (Class I; Level of Evidence B).
Cerebral angioplasty and/or selective intra-arterial vasodilator therapy is reasonable in patients with symptomatic cerebral vasospasm, particularly those who are not rapidly responding to hypertensive therapy (Class IIa; Level of Evidence B).

Cushing reflex

2022-08-23 12:28:28 UTC

Physiological nervous system response to acute elevations of intracranial pressure.
Leads to Cushing’s triad of widened pulse pressure (increasing systolic, decreasing diastolic), bradycardia, and irregular respirations

In the first stage of the Cushing reflex, blood pressure and heart rate rise in response to sympathetic activation to overcome increases in ICP.

This sympathetic response allows for brain perfusion as long as the ICP is not too high to overcome. For the brain to remain adequately perfused, mean arterial pressure (MAP) must be maintained higher than ICP.

In the second stage of the Cushing reflex, hypertension continues to be present, but the patient becomes bradycardic rather than tachycardic.

Wide acceptance that bradycardia is a late-stage and likely terminal sign of worsening intracranial pathology.

Blood pressure will continue to rise until the MAP overcomes the ICP, and blood can adequately perfuse the brain, thereby resolving hypoxia and avoiding infarction.

In the later stages of the Cushing reflex, brainstem dysfunction secondary to increased ICP, tachycardia, or bradycardia is observable clinically as an irregularity in breathing; this is characterized initially by shallow breaths with occasional periods of apnea.

This activity occurs due to compression of the brainstem by increased ICP, and as a result, distortion of the respiratory centers.

Eventually, agonal breathing may develop as herniation of the brain begins, progressing to respiratory and cardiac arrest.

Overall, it seems that the Cushing reflex is the very last hemodynamic response to a systemic sympathetic activation that follows the acute rise in ICP.

Cerebral vasospasm

2022-08-23 14:44:02 UTC

Vasospasm typically begins no earlier than day 3 after haemorrhage, reaching a peak at days 7 to 8.

Vasospasm can also occur even at the time of hospital admission.

Vasospasm is believed to be produced by spasmogenic substances (substance which induce spasm) generated during the lysis of subarachnoid blood.

Drugs for vasospasm

2022-08-23 14:52:47 UTC

Intra-arterial administration of vasodilators are generally used for diffuse vasospasm involving smaller arterial branches.

Various article reported as effective for improving vasospasm in case series include intra-arterial nicardipine, milrinone, papaverine, nimodipine, verapamil, and intrathecal nitroprusside. Intra-arterial vasodilator therapy and angioplasty also may be used in combination.

Often mentioned as the worst headache ever experienced by the patients

2022-08-24 01:30:46 UTC

How DI is diagnosed

Charlotte_Nttt — 2022-08-24 03:26:03 UTC

Prognosis

yenqi_chewychew — 2022-08-24 10:18:15 UTC

Case fatality for SAH is high with outcome that’s less than half. One-third of patients will survive with good recovery; one-third would survive with a disability; and one-third will die.
thus prevention is one of the very way to bring substantial improvement, early recognition of sign and symptom of SAH could bring a good outcome and recovery of SAH.

Hunt and Hess scale

yenqi_chewychew — 2022-08-24 10:37:43 UTC

The hunt and Hess scale

The Hunt and Hess scale describes the clinical severity of SAH resulting from the rupture of an intraceleberal aneurysms and is widely used as a predictor of survival rate. Grades 1, 2 and 3 have better outcomes than 4 and 5.

WFNS clinical scale

yenqi_chewychew — 2022-08-24 10:38:46 UTC

WFNS clinical scale
The World Federation of Neurological Surgeons as grades SAH according to motor score and total GCS. Their grading scale gives us an idea as to what to expect in terms of survival. Advantage is that it uses the GCS score to identify the grading.

Glasgow coma scale

yenqi_chewychew — 2022-08-24 10:43:53 UTC

The Glasgow Coma Scale (GCS) is used to describe the extent of impaired consciousness in all types of acute medical and trauma patients, baseline to determine patients neurological changes. GCS had less detailed description yet it can provide a useful summary of the overall severity.

Despite the usefulness of GCS, there’s some disadvantages of GCS such as,

It’s hard to apply for those with hearing loss or speech impediment.
If a patient is intubated or unable to speak, they are evaluated only on the motor and eye-opening response and the suffix T is added to their score to indicate intubation.
If patient is sedated or paralysed, GCS should not be valid thus if possible, the clinician should obtain the score before sedating the patient to at least gain the baseline of the patients score as comparison thereafter.

Temperature management using Blanketrol machine for patients with strict ICP control with IV sedation

jarindaho1 — 2022-08-24 14:07:34 UTC

Recommendation ventilator setting algorithm

cack1019 — 2022-08-27 03:52:21 UTC