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Prognostication in Neuro Disasters
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Prognostication in Neuro Disasters

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Oli Flower discusses the tricky issue of prognostication in neuro disasters. This includes intracerrebral haemorrhage, traumatic brain injury, subarachnoid haemorrhage and ischaemic stroke. From …

Oli Flower discusses the tricky issue of prognostication in neuro disasters. This includes intracerrebral haemorrhage, traumatic brain injury, subarachnoid haemorrhage and ischaemic stroke. From Bedside Critical Care 2013 in Cairns. Go to Intensive Care Network for the audio and much more.

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Transcript

  • 1. PROGNOSTICATION! AFTER! NEURO! DISASTERS
  • 2. ICH
  • 3. size image by Geigy
  • 4. age image by Bev Sykes
  • 5. GCS photo by og2t // ou gee tew tee
  • 6. LOCATION LOCATION LOCATION
  • 7. ABOVE OR BELOW THE TENT photo by Michael Matti
  • 8. DEMENTIA photo byKurt Komoda
  • 9. func
  • 10. 84M! GCS 7! 80 ml ICH! Basal ganglia bleed! Some IVH! Mild cognitive impairment
  • 11. 72F! GCS 10! 20 ml ICH! Lobar bleed! No IVH! No cognitive impairment
  • 12. TBI
  • 13. GCS
  • 14. GCS SHOCK
  • 15. GCS SHOCK >60
  • 16. GCS SHOCK >60
  • 17. GCS SHOCK >60
  • 18. GCS SHOCK >60
  • 19. Australia! 37M! GCS 3! Pupils reacting! No hypoxia or hypotension! Isolated TBI! CT with petichial haemorhages, mass effect 3rd ventricle compressed, no SAH, no MLS! BGL 7.0 Hb 8.8
  • 20. aSAH
  • 21. 35% photo by liquidnight
  • 22. photo by Keoni Cabral DISABILITY CAN BE HARD TO MEASURE
  • 23. GRADE! AGE BLOOD
  • 24. GCS photo by og2t // ou gee tew tee
  • 25. H H 1 Asymptomatic, mild headache, slight nuchal rigidity 2 Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy 3 Drowsiness / confusion, mild focal neurologic deficit 4 Stupor, moderate-severe hemiparesis 5 Coma, decerebrate posturing
  • 26. Grade GCS Motor deficit I 15 - II 13-14 - III 13-14 + IV 7-12 -/+ V 3-6 -/+
  • 27. CARTER
  • 28. So this means.....? photo by Leo Reynolds photo by Leo Reynolds
  • 29. HCP SEIZURE SEIZURE DRUGS
  • 30. THE! HISTORY
  • 31. THE! ANEURYSM
  • 32. AED
  • 33. ANAEMIA HYPERGLYCAEMIA ICU COMPLICATIONS LOW VOL CENTRES
  • 34. STROKE
  • 35. 16 6 42
  • 36. LEVEL! OF! CONSCIOUSNESS
  • 37. HORIZONTAL EYE MOVEMENT
  • 38. VISUAL! FIELDS
  • 39. FACIAL! PALSY
  • 40. MOTOR:! ARMS
  • 41. MOTOR:! LEGS
  • 42. LIMB! ATAXIA
  • 43. SENSORY
  • 44. LANGUAGE & SPEECH
  • 45. Inattention
  • 46. The patient and family understand the potential risks and benefits of therapy
  • 47. SPAN-100
  • 48. ICH SCORE FUNC! TBI IMPACT CRASH! SAH WFNS! CVA NIHSS
  • 49. BE! AN! INFORMED! AGNOSTIC.