TAILIEUCHUNG - Consulting and solving critical: Part 2

(BQ) Continued part 1, part 2 of the document Consulting and solving criticalhas contents: Post - cardiac arrest support and the brain, acquired weakness in the intensive care unit, neurology of polytrauma, neurooncology emergencies, troubleshooting - ICU neurotoxicology. Invite you to refer. | 6 Post-Cardiac Arrest Support and the Brain A frequent reason for a neurology consult in the intensive care unit ICU is to assess a comatose patient after cardiopulmonary resuscitation CPR and adequate resumption of spontaneous circulation. This is also one of the most difficult tasks. Cynics may argue that the neurologist may not be needed to assess the prognosis of a comatose patient one or two days after CPR the patient s chances for good recovery are poor. Unfortunately there is a misconception that is all there is to it. The rate of mortality and poor outcome in most recent studies of surviving comatose patients after CPR however has remained at about 50 .41 42 The key to successful outcome is having a bystander who not only is able to do CPR but also has knowledge and skill in doing so. Once patients are resuscitated it is common practice to move them to the coronary artery catheterization suite and patients may benefit from urgent revascularization. For the neurologist seeing a patient for the first time five main questions as well as subsidiary questions should be asked 1 Is there any possibility that cardiac arrest was a consequence of an acute catastrophic intracranial hemorrhage and what did the computed tomography CT scan of the brain show 2 What is the patient s cardiac reserve and how advanced is current support 3 When was hypothermia started and what supportive medication and in what dose is being used 4 Is there evidence of liver or kidney injury that could slow drug metabolism 5 Is electroencephalography EEG monitoring in place and warranted or has a spot EEG excluded ongoing seizures Over the last decade the practice of neurologic assessment of patients with acute severe brain injury after cardiac standstill has become more complicated as a result of cooling the use of additional sedation and neuromuscular junction blockers and especially the introduction of extracorporeal membrane oxygenation ECMO .27 28 32 With all that noise and confounding the

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• Solving critical consults
• Post−Cardiac arrest support
• The brain
• Acquired weakness
• Neurology of polytrauma
• Neurooncology emergencies
• The intensive care unit
• Acute confusion
• The critically ill
• Organ dysfunction
• The postoperative cardiac patient