Bart Besinger’s Tips for TBI

Bart Besinger’s Tips for TBI - Part 1

This week we will discuss Bart'sTips for TBI,it entails 5 topics:

Positioning,cervical collar,Blood Pressure,Blood sugar,and Temperature.

Today we discuss the first two items:

Patient Position

Elevating the head of the bed to 30° — will decrease ICP via displacing the CSF and increasing venous outflow.

By elevating the head of the bed to between 30°-45° also decrease the risk of developing ventilator associated pneumonia.

However elevating the head of the bed can be difficult in the patient with spinal precautions.

Bart also recommends avoiding the trendelenburg position (especially when inserting central lines) as this intervention offer’s little benefit but can greatly increase the ICP.

Cervical Collar

C-Spine collar aka “The Brain Tourniquet”.

Clearing the cervical spine of these patients can often be difficult in the comatosed intubated patient.

Removal of the C-spine collar has been showen to decrease ICP by around 2-5 mmHg.

If you are unable to remove the cervical collar check the position, size and tightness of the collar. Bart’s tip: loosen it up a bit so it aids venous return but still supports the head

Comments

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is caffeine prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg, dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...

sedationstation

Search This Blog