Haemodynamics · TBI General · Traumatic Brain Injury

Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?

It is widely accepted that hypotension in patients with traumatic brain injury is associated with poorer outcomes, as confirmed in a number of studies. But is there really a reliable cut-off for when we should be happy with a TBI patient´s blood pressure in a prehospital setting? A recent article in JAMA Surgery (Spaite et… Continue reading Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?

Decompressive Surgery · discussions · ICP/CPP management · TBI General · Traumatic Brain Injury

RESCUEicp Trial Results Finally Out: Craniectomy in TBI Lowers Mortality, But Survivors Suffer Worse Neurological Outcomes

After completing recruitment of some 408 TBI patients in 2014, the RESCUEicp group finally published the results from this eagerly awaited trial. The article by Hutchinson et al, titled Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, was published on September 7th in the New England Journal of Medicine. So let´s go straight to the core: The study… Continue reading RESCUEicp Trial Results Finally Out: Craniectomy in TBI Lowers Mortality, But Survivors Suffer Worse Neurological Outcomes

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

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · TBI General

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

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

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

Eurotherm 3235 Trial

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

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

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