Secondary brain injury occurs after the initial primary brain injury and can develop hours or days later due to complications from the primary mechanism of injury. Neurocritical care aims to prevent secondary brain injuries by maintaining adequate oxygenation and circulation to the brain and managing factors like intracranial pressure and hypotension that can exacerbate the initial injury. However, the best time to save neurons is before they reach the neurocritical care unit since once there, the damage may already be done.

3. When does Primary become Secondary Injury?
On scene ED NCCU
Secondary brain injury occurs after the primary mechanisms of injury have run their course (Gennarelli & Graham, 2005)
Secondary brain injuries often result from complications of the primary mechanism of injury and may occur anywhere from
hours to days after the initial injury (Dawodu, 2007)

4. So at best
Neurocritical Care will only save
neurons that have not died

5. NCCU Has 3 functions
Maintain Airway Good Nursing Care Weaning from Ventilator

7. A S S O O N A S W E G E T I N V O LV E D W E C A N
E A S I LY D O H A R M

8. utter cluster
fxxx /
abject harm
perfect
care
/ good outcome
The Spectrum of Neuro Critical Care
The good
perfectionist
The bad
perfectionist Nature
Where most of us practice
{

9. BUT WE MUST STOP SECONDARY INJURY….
Like Hypotension?

11. BUT WE MUST STOP SECONDARY INJURY….
Like ICP?

14. HYPERVENTILATION
1982 Good 2002 Bad

15. C O O L I N G

16. J U G U L A R V E N O U S S AT U R AT I O N
Who regularly does this?

17. B R A I N O X Y G E N AT I O N

18. B R A I N
O X Y G E N AT I O N

19. So we await….

20. S T E R O I D S
2004 Bad1985 Good

21. N E U R O P R O T E C TA N T S … .

22. N T E R V E N T I O N S
T H AT D O H E L P
e.g. Dialysis
….But these are not NCCU specific

23. N T E R V E N T I O N S
T H AT D O H E L P
e.g. Antibiotics
….Probably don’t need ITU

24. The Time to Save neurons is
BEFORE Neurocritical care
Once there… In the spontaneously breathing patient…

25. than NOB THERAPYIs all this really better
Ventilation
Art Line
Central Line
Vasopressors
ICP
Licox
Microdialysis
TPN
Tracheostomy

26. Neurocritical care is no better than

28. W H AT H A P P E N S I F
S H O W S D E C O M P R E S S I O N B A D ?