Author: andersfeyling

Airway Management · TBI General · Traumatic Brain Injury · Ventilation and Oxygenation

SJTREM: Physician Staffed EMS Associated With Improved Outcomes From TBI

andersfeylingLeave a comment

In a recent article in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine by Pakkanen et al, retrospective data from a Finnish prehospital service is presented. They looked at prehospital management of severe TBI (severe head injury with GCS 8 or lower) over a 6-year period, including some 458 patients for analysis. They found a… Continue reading SJTREM: Physician Staffed EMS Associated With Improved Outcomes From TBI

Acute Cerebrovascular Conditions · Haemodynamics · Neuromonitoring · Subarachnoid Haemorrhage

Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage

andersfeylingLeave a comment

Published in 2011 by Schmidt et al (free full-text in Stroke), this article looks at CPP thresholds for cerebral hypoxia in SAH patients. They went through multimodal monitoring data for 30 patients with poor-grade SAH. Using microdialysis and brain tissue oxygenation as their main determinants of hypoxia, they found that patients with a CPP <70… Continue reading Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage

Conferences

Invitation: Kick Off Symposium on Neuromodulation of Neuropathic Pain and Headache disorders

andersfeylingLeave a comment

Keep the date: September 9th 2016 at Rikshospitalet, Oslo, Norway. The Kick Off Symposium on Neuromodulation of Neuropathic Pain and Headache Disorders welcomes a range of speakers, Norwegian and international, with expertise in the field. The symposium is free of charge and open to anyone with interest in the area. Could be relevant to a range of… Continue reading Invitation: Kick Off Symposium on Neuromodulation of Neuropathic Pain and Headache disorders

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · TBI General

To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

andersfeylingLeave a comment

There´s a paucity of guidelines and recommendations on diagnostic pathways in patients on warfarin who sustain head injuries. This article by Alrajhi et al from 2015 (J Emerg Med) looked at an historical cohort of patients on warfarin admitted for either minor (Glasgow Coma Score 13-15, with loss of consciousness, amnesia, or confusion) or minimal (Glasgow Coma Score… Continue reading To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · Haemodynamics · Intracerebral Haemorrhage

ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH

andersfeyling2 Comments

Published in NEJM 2016, the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) trial compared two BP-management regimes in intracerebral haemorrhage patients with hypertension (SBP>180 mmHg): Intensive lowering to SBP 110-139 mm Hg. vs. standard treatment to within the 140-179 mm Hg range. The trial was discontinued early after an interim analysis showed no difference between the groups in… Continue reading ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · Intracerebral Haemorrhage

PATCH – Trial: Platelets in ICH Harmful

andersfeyling1 Comment

Transfusing thrombocytes to patients taking anti-platelet therapy who develop an intracerebral hemorrhage seems to confer harm, according to the authors of the PATCH trial (abstract). Published recently in the Lancet by Baharoglu et al, this multicentre RCT included 190 patients in order to determine whether platelet transfusion reduces extent of haemorrhage, thereby improving outcome, in ICH associated with… Continue reading PATCH – Trial: Platelets in ICH Harmful

ICP/CPP management · Neuroprotection · TBI General · Thermoregulation · Traumatic Brain Injury

Eurotherm 3235 Trial

andersfeyling3 Comments

The long-awaited Eurotherm trial was published in NEJM in autumn 2015. The premise of the study was to examine the impact of induced hypothermia on outcomes after traumatic brain injury. In a multi center randomized controlled trial patients were allocated to either therapeutic hypothermia (32-35 degrees) or the control group (standard care, normothermia). The study… Continue reading Eurotherm 3235 Trial

Conferences · discussions · SMACC Dublin · TBI General · Traumatic Brain Injury

SMACC Dub Neuro Take Home

andersfeylingLeave a comment

SMACC Dublin is behind us. It was a phenomenal 3 days of inspiring talks, discussions and events. Here are a few neuro-related impressions: Martin Smith (Neurocritical Care consultant at the National Hospital for Neurology and Neurosurgery in the UK) gave a solid talk highlighting the challenges pertaining to the concept of brain death, especially the… Continue reading SMACC Dub Neuro Take Home

Fluid Management · Haemodynamics · Osmotherapy · Subarachnoid Haemorrhage · TBI General

Critical Care: Fluid Therapy in Neurological Patients

andersfeylingLeave a comment

Right off the press: an open access review article from Critical Care on fluid therapy in the neurological patient. It provides a nice synopsis of the different fluid therapy paradigms that are advocated through various guidelines. The review challenges some of the tenets of basic treatment, such as empirical fluid maintenance and the definition of… Continue reading Critical Care: Fluid Therapy in Neurological Patients