Acute Cerebrovascular Conditions · Anaesthetic Agents · Ischaemic Stroke · Neuroanaesthesia · Sedation

AnStroke Trial: Anaesthesia vs. Sedation for Endovascular Treatment of Ischemic Stroke

Does choice of anaesthetic approach have an impact on neurological outcomes in stroke patients? This article, recently published in Stroke, examines outcomes in patients undergoing endovascular treatment for acute ischemic stroke, randomised to either conscious sedation or general anaesthesia. Retrospective material till now has suggested poorer outcomes in patients subjected to full anaesthesia when compared… Continue reading AnStroke Trial: Anaesthesia vs. Sedation for Endovascular Treatment of Ischemic Stroke

Airway Management · Cervical Spine Injury · Traumatic Brain Injury

A Few Handy Resources on Airway Management

Patients with head- and neck injuries can have challenging airways. We often use videolaryngoscopes or flexible fibrescopes (single use scope) when performing intubation in such patients. Our colleagues in Copenhagen have put together a useful website with videos and other learning resources on that subject. They also arrange an annual  two-day airway course with a very extensive workshop. Read more… Continue reading A Few Handy Resources on Airway Management

Airway Management · Neurocritical Care · Neurotrauma · Traumatic Brain Injury

More Brain Impact Apnoea

Brain impact apnoea causes secondary brain injury.  The duration of the apnoea reflects the energy in the injury. We often see these patients in our trauma center as they come intubated. CT-scan can reveal structural brain damage or bleeding. In some pastients the CT-scan is “normal”. However, the brain may have suffered hypoxic injuries undetectable with… Continue reading More Brain Impact Apnoea

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

SJTREM: Physician Staffed EMS Associated With Improved Outcomes From TBI

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

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

Critical Care: Fluid Therapy in Neurological Patients

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

Airway Management · Systemic Effects of CNS Pathology · TBI General · Ventilation and Oxygenation

Brain Impact Apnea

Immediate apnea after acute head trauma is a concept that has received renewed focus lately. BIA/IBA (Brain Impact Apnea or as some call it, Impact Brain Apnea) was described in animal models as far back as 1874 by Koch and Filehne (1). A number of subsequent studies (2-5) have established a clear link between severity of impact and duration of… Continue reading Brain Impact Apnea

Airway Management · Podcasts

Awake Intubation Lecture from SMACC

“Dry them out”; use glycopyrrolate (no central effects). How to use local anesthetics and more…  Listen to the podcast here. EMcrit recommend: Airway Regional Anesthesia for Awake Fiberoptic Intubation, Simmons et al, Regional Anesthesia and Pain Medicine 2002. Read the review article here. Fibreoptic vs videolaryngoscopic (C-MAC(®) D-BLADE) nasal awake intubation under local anesthesia. Kramer et al. Anaesthesia. 2015… Continue reading Awake Intubation Lecture from SMACC