1. monitoring of the neurocritically ill patient in the emergency department scott weingart

2. Sick Heads Don’t Take A Joke

3. who am I?

9. What is this talk based on?

10. Brain Trauma Foundation Management and Prognosis of Severe Traumatic Brain Injury http://braintrauma.org

13. Neuro- Trauma and other sick heads

14. Who Are You?

15. where are you?

16. what’s your motivation?

19. Sick Heads Don’t Take A Joke

20. What’s funny in the ED?

21. Sick Heads Don’t Take A Joke

22. Sick Heads don’t Autoregulate

23. Secondary Injury

24. Secondary Injury = Our Fault

25. Monitoring

26. 1. Basic Monitoring 2. Advanced Monitoring 3. ICP Monitoring

27. 1. Things you Must Do 2. Things you Should Do 3. Things your pt needs like a hole in the head

29. CPP=MAP-ICP

30. Non-Invasive Blood Pressure

31. SBP>9 0 MAP>9 0

32. 90-30 =60

33. Pulse Ox

34. 95- 100%

35. Sedation

37. Little Things

38. Glasgow Coma Scale

40. Sit ‘em up

41. HOB @ 45 °

42. ETCO 2

45. ETCO2<35 PaCO2 35-38

46. C 6 H 12 O 6

47. Glucose 80-150

48. NaNa

49. Push Na to ~150 Never <140

50. NaClmOsm/ L NS154 308 LR130109273

51. Os m

52. Do not go beyond 320

53. A-line

55. * Beat to Beat BP * Blood Sampling * Volume Status

56. CV P

57. Urine Output

58. Keep Fluid Balance Positive

59. Tem p

60. <100° F

62. O In 

63. who needs it?

64. (GCS 3-8) with abnormal head CTs GCS (3-8) with normal CTs and two of the following: SBP<90 Posturing Age>40

66. Camino

69. IVC

71. CPP=MAP-ICP

72. ICP 60

73. Compliance

74. Ocular Ultrasound

77. Review

78. GCS

79. MAP>9 0

80. Sat>95

81. Keep Sedated

82. HOB at 45 °

83. ETCO 2 <35

84. PCO 2 35-38

85. Push Na to ~150 Never <140

86. Glucose 80-150

87. OSM < 320

88. Aline

89. Temp <100

90. Fluid Balance Postive

91. ICP<20

92. CPP>60

93. Not going to mess with a non-compliant head

95. Monitoring = Control

96. “A fool with a tool is still a fool”

97. me@emcrit.org www.emcrit.org

98. * Selected References are in your syllabus * All references at my web site * Presentation Style inspired by Lawrence Lessig