PROGNOSTICATION!
AFTER!
NEURO!
DISASTERS
ICH
size

image by Geigy
age
image by Bev Sykes
GCS
photo by og2t // ou gee tew tee
LOCATION
LOCATION
LOCATION
ABOVE OR BELOW THE TENT

photo by Michael Matti
DEMENTIA

photo byKurt Komoda
func
84M!
GCS 7!
80 ml ICH!
Basal ganglia bleed!
Some IVH!
Mild cognitive impairment
72F!
GCS 10!
20 ml ICH!
Lobar bleed!
No IVH!
No cognitive impairment
TBI
GCS
GCS

SHOCK
GCS

SHOCK

>60
GCS

SHOCK

>60
GCS

SHOCK

>60
GCS

SHOCK

>60
Australia!
37M!
GCS 3!
Pupils reacting!
No hypoxia or hypotension!
Isolated TBI!
CT with petichial haemorhages,
mass effec...
aSAH
35%
photo by liquidnight
photo by Keoni Cabral

DISABILITY CAN BE HARD TO MEASURE
GRADE!
AGE
BLOOD
GCS
photo by og2t // ou gee tew tee
H
H

1

Asymptomatic, mild headache, slight nuchal rigidity

2

Moderate to severe headache, nuchal rigidity, no
neurologi...
Grade

GCS

Motor deficit

I

15

-

II

13-14

-

III

13-14

+

IV

7-12

-/+

V

3-6

-/+
CARTER
So this means.....?

photo by Leo Reynolds

photo by Leo Reynolds
HCP

SEIZURE

SEIZURE

DRUGS
THE!
HISTORY
THE!
ANEURYSM
AED
ANAEMIA

HYPERGLYCAEMIA

ICU COMPLICATIONS

LOW VOL CENTRES
STROKE
16
6 42
LEVEL!
OF!
CONSCIOUSNESS
HORIZONTAL

EYE MOVEMENT
VISUAL!
FIELDS
FACIAL!
PALSY
MOTOR:!
ARMS
MOTOR:!
LEGS
LIMB!
ATAXIA
SENSORY
LANGUAGE &
SPEECH
Inattention
The patient and family understand the
potential risks and benefits of therapy
SPAN-100
ICH SCORE FUNC!
TBI IMPACT CRASH!
SAH WFNS!
CVA NIHSS
BE!
AN!
INFORMED!
AGNOSTIC.
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
Prognostication in Neuro Disasters
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 Bedside Critical Care 2013 in Cairns. Go to Intensive Care Network for the audio and much more.

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Prognostication in Neuro Disasters

  1. 1. PROGNOSTICATION! AFTER! NEURO! DISASTERS
  2. 2. ICH
  3. 3. size image by Geigy
  4. 4. age image by Bev Sykes
  5. 5. GCS photo by og2t // ou gee tew tee
  6. 6. LOCATION LOCATION LOCATION
  7. 7. ABOVE OR BELOW THE TENT photo by Michael Matti
  8. 8. DEMENTIA photo byKurt Komoda
  9. 9. func
  10. 10. 84M! GCS 7! 80 ml ICH! Basal ganglia bleed! Some IVH! Mild cognitive impairment
  11. 11. 72F! GCS 10! 20 ml ICH! Lobar bleed! No IVH! No cognitive impairment
  12. 12. TBI
  13. 13. GCS
  14. 14. GCS SHOCK
  15. 15. GCS SHOCK >60
  16. 16. GCS SHOCK >60
  17. 17. GCS SHOCK >60
  18. 18. GCS SHOCK >60
  19. 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. 20. aSAH
  21. 21. 35% photo by liquidnight
  22. 22. photo by Keoni Cabral DISABILITY CAN BE HARD TO MEASURE
  23. 23. GRADE! AGE BLOOD
  24. 24. GCS photo by og2t // ou gee tew tee
  25. 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. 26. Grade GCS Motor deficit I 15 - II 13-14 - III 13-14 + IV 7-12 -/+ V 3-6 -/+
  27. 27. CARTER
  28. 28. So this means.....? photo by Leo Reynolds photo by Leo Reynolds
  29. 29. HCP SEIZURE SEIZURE DRUGS
  30. 30. THE! HISTORY
  31. 31. THE! ANEURYSM
  32. 32. AED
  33. 33. ANAEMIA HYPERGLYCAEMIA ICU COMPLICATIONS LOW VOL CENTRES
  34. 34. STROKE
  35. 35. 16 6 42
  36. 36. LEVEL! OF! CONSCIOUSNESS
  37. 37. HORIZONTAL EYE MOVEMENT
  38. 38. VISUAL! FIELDS
  39. 39. FACIAL! PALSY
  40. 40. MOTOR:! ARMS
  41. 41. MOTOR:! LEGS
  42. 42. LIMB! ATAXIA
  43. 43. SENSORY
  44. 44. LANGUAGE & SPEECH
  45. 45. Inattention
  46. 46. The patient and family understand the potential risks and benefits of therapy
  47. 47. SPAN-100
  48. 48. ICH SCORE FUNC! TBI IMPACT CRASH! SAH WFNS! CVA NIHSS
  49. 49. BE! AN! INFORMED! AGNOSTIC.

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