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)
So at best
Neurocritical Care will only save neurons that have not died
NCCU Has 3 functions
Maintain Airway Good Nursing Care Weaning from Ventilator
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
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
{
BUT WE MUST STOP SECONDARY INJURY….
Like Hypotension?
BUT WE MUST STOP SECONDARY INJURY….
Like ICP?
HYPERVENTILATION1982 Good 2002 Bad
C O O L I N G
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?
B R A I N O X Y G E N AT I O N
B R A I N O X Y G E N AT I O N
So we await….
S T E R O I D S
2004 Bad1985 Good
N E U R O P R O T E C TA N T S … .
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
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
The Time to Save neurons is BEFORE Neurocritical care
Once there… In the spontaneously breathing patient…
than NOB THERAPYIs all this really better
Ventilation Art Line
Central Line Vasopressors
ICP Licox
Microdialysis TPN
Tracheostomy
Neurocritical care is no better than
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 ?