Neurotrauma Management for the Severely Injured Polytrauma Patient

 

Description:

         This text addresses many of the questions which occur when medical professionals of various disciplines interact and have different plans and interventions, each with its own valid scientific and/or experience-based rationale:  Questions involving tourniquet placement, ideal fluids and volumes for resuscitation, VTE prophylaxis and many other management considerations. Straightforward decisions in the patient with a single diagnosis often conflict when applied to the neurologically injured polytrauma patients.         Neurotrauma Management for the Severely Injured Polytrauma Patient answers as many of these questions as possible based on the current literature, vast experience with severe neurotrauma in the current conflicts in Afghanistan and Iraq, and the experience of trauma experts across the globe as well as proposes areas for future study where answers are currently less clear.  

 

 

Table of Contents:

 

General Principles and Trauma System Management

1 The Difficult Conversation

References

2 Communication Between Teams and Multidisciplinary Rounds and Single Primary POC for Family Communi

Introduction

The Role for Teamwork

Who Should Lead the Multidisciplinary Team?

Communication with the Patient/Caregiver

Our Experience Building the Team

Conclusion

References

3 Mass Casualty Events and Your Hospital

Planning

Facility Considerations

Triage

Nonurgent Casualties

Urgent Casualties

Expectant Casualties

Patient Identification

Undertriage and Overtriage

Pitfalls

References

4 Rural and Austere Environments

Rural and Austere Environments

References

5 Prehospital Care and EMS Considerations in the Polytrauma Patient with CNS Injuries

References

Arrival at Facility

6 AIS Versus ISS Versus GCS—What’s Going on Here?

Introduction

Glasgow Coma Scale (GCS)

Abbreviated Injury Score (AIS) and Injury Severity Score (ISS)

GCS, AIS, and ISS Combinatorial Predictive Value

Conclusions

References

7 Trauma Resuscitation and Fluid Considerations in the Polytrauma Patient with CNS Injury

Introduction

Fluid Balance

Crystalloids Versus Colloids

Hyperosmolar Therapy

Other Crystalloids

Blood Products

Other Considerations

Neurocritical Care Targets of Resuscitation

Future Directions

References

8 Initial Imaging Considerations, Repeat Imaging Frequency

Overview of Trauma Imaging

Imaging of the Brain

Indications for Imaging

Imaging Findings

Role of MRI

Follow Up Imaging

Outcome Prediction

Brain Death

Imaging of Blunt Cerebrovascular Injuries

Indications for Screening

Imaging of BCVI

Follow up Imaging

Intracranial BCVI

Imaging of the Spine

Indications for Imaging

Imaging Modalities

Injury Types

Spinal Stability

References

9 Evidence-Based Review of the Use of Steroids in Neurotrauma

References

10 Interventional Radiology in the Civilian Neurotrauma Setting

Anatomic Overview

Anatomic Structure of the Artery

Great Vessels of the Aortic Arch

Segments of the Carotid Artery

Segments of the Vertebral Artery

Imaging Modalities for Diagnosis

Ultrasound

CT Angiography

MRI/MR Angiography

Digital Subtraction Angiography (DSA)

The Signs and Symptoms—What to Look Out for

Treatments Options for Vessel Injury

The Conservative Approach—Maximizing Medical Therapy

The Surgical Approach—Proven Over Time

The Endovascular Approach—First-Line Alternative to Conservative Treatment

References

11 Vertebral Artery Injuries in Penetrating Neck and Cervical Spine Trauma

Anatomy of the VA (Fig. 11.1) [4, 17]

Zones of the Neck (Fig. 11.2)

Patterns of VA Injury

Associated Injuries

Principles of Management

Unstable Patients

Stable Patients

Intimal Injury/Dissection (Denver Grades I and II)

Occlusion (Denver Grade IV)

Pseudoaneurysm (Denver Grade III)

Arteriovenous Fistula (Denver Grade III or V)

Prognosis and Outcome

Penetrating Cervical Spine Injuries

References

12 Clearing the Cervical Spine in Blunt Trauma

Clinical Evaluation

Imaging

Screening CT Scan Is Positive

Screening CT Scan Is Negative

The Alert Patient

The Obtunded Patient

Pediatric Patients

Conclusion

References

13 Initial Evaluation and Management

Introduction

Overall Approach to the Unstable Patient

Primary Survey

Airway

Breathing

Circulation

Disability

Exposure—Environment

Monitoring

Assessment and Secondary Survey

Traumatic Brain Injury

Summary

References

14 Transport of the Neurotrauma Patient

Introduction

Mode of Prehospital Transport and Receiving Location

PreTransport Considerations

Stressors of Flight

Neurocritical Care During Transport

Neurocritical Care Standard Bundles

Complications and Management Considerations During Transport

Summary

References

The Operating Room/Damage Control

15 Multiple Surgical Teams in the O. R. at Once—Priority of Effort and Who Takes the Lead?

Introduction

Roles and Responsibilities in Initial Evaluation

Priorities in the Initial Resuscitation

Preoperative Priorities and Decision-Making

Response to Resuscitation

Priority of Procedure

Spine Immobilization

Positioning in the Operating Room

Intracranial Pressure Monitoring

Increased Intracranial Pressure During Laparotomy or Thoracotomy

References

16 Laparotomy for Refractory ICP

Conclusion

References

17 Associated Musculoskeletal Injuries

Introduction

Polytrauma

Notable Associated Orthopaedic Injuries

Compartment Syndromes

Damage-Control Orthopaedics

Timing of Spine Surgery

Conclusion

References

18 Neuro Anesthetic Considerations

References

19 Decompressive Craniectomy for Severe TBI

Introduction

Pathophysiology of Closed and Penetrating Head Injuries

Current Guidelines

Outcomes

Military Penetrating TBI

Civilian Penetrating TBI

Closed TBI

General Background

Setup and Positioning

Unilateral Hemispheric Craniectomy

Bifrontal Craniectomy

Complications

Frontal Sinus Injury Repair

Illustrative Cases

Conclusion

References

ICU Care

20 Hemodynamic Considerations in the Polytrauma Patient with Traumatic Brain Injury (TBI)

Epidemiology and Normal Physiology

Cerebral Blood Flow

Resuscitation with Crystalloids or Colloids

Vasopressors

Packed Red Blood Cell (pRBC) Transfusion

Intracranial Pressure

Brain Tissue Oxygen and Microdialysis

References

21 Coagulopathy in Traumatic Brain Injury

Coagulopathy in Traumatic Brain Injury

References

22 Venous Thromboembolism Prophylaxis

Overview

Traumatic Brain Injury

Choice of Anticoagulant and Dose

Timing of Initiation

National Guidelines

Spinal Cord Injury

Choice of Anticoagulant and Dose

National Guidelines

Prophylactic Vena Cava Filters

National Guidelines

Future Directions

References

23 Mechanical Ventilation in Traumatic Brain Injury

Introduction

Epidemiology

Indications for Mechanical Ventilation

Intracranial Physiology and the Effects of Mechanical Ventilation

Mechanical Ventilation Strategies

Selection of Optimal Rate and Tidal Volume

Optimization of Oxygenation—Positive End Expiratory Pressure (PEEP) and Fraction of Inspired Oxyge

Positive End Expiratory Pressure (PEEP)

Fraction of Inspired Oxygen (FiO2)

Rescue Modalities for Severe Hypoxemic Respiratory Failure

Airway Pressure Release Ventilation (APRV)

Prone Positioning

Nitric Oxide

Paralytics

Extracorporeal Membrane Oxygenation (ECMO)

Conclusion

References

24 Nutrition, Antibiotics, and Post-traumatic Seizure Prophylaxis

Nutrition in the Intensive Care Unit

Antibiotic Stewardship in the Intensive Care Unit

Prophylactic Antibiotics for Intracranial Pressure Monitors

Pharmacological Seizure Prophylaxis for Patients with Traumatic Brain Injury

References

25 Therapeutic Hypothermia for Traumatic Brain Injury and Spinal Cord Injury

Introduction

Background

Traumatic Brain Injury

Spinal Cord Injury

Managing Intracranial Hypertension

Conclusions

Disclaimer

References

Follow Up Care and Rehabilitation

26 Rehabilitation in the Setting of Neurotrauma

Introduction

Negative Effects of Immobility

Musculoskeletal System

Treatment

Contractures

Treatment

Spasticity

Treatment

Heterotopic Ossification (HO)

Treatment

Cardiovascular

Orthostatic Hypotension

Treatment

Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE)

Treatment

Pulmonary

Treatment

Gastrointestinal

Treatment

Urinary System

Treatment

Integumentary System

Treatment

Psychiatric

Treatment

Pain

Treatment

Interdisciplinary Rehabilitation Team Members

Rehabilitation Principles for Special Categories of Patients

Traumatic Brain Injury

Common Sequelae and Treatment

Spinal Cord Injury (SCI)

Common Sequelae and Treatment

Peripheral Nerve Injuries

Treatment

Conclusion

References

27 Craniofacial Reconstruction in the Polytrauma Patient

Introduction

Acute care

Care Coordination

Infection

Challenges of Military Craniofacial Trauma

Acute Fracture Care

Secondary Reconstruction

Syndrome of the Trephined

Treatment Methodology

Reconstructive Materials

Large-Scale Cranial Defect Reconstruction

Complex Craniofacial Reconstruction

Conclusions

References

28 Functional Restoration for Neurological Trauma: Current Therapies and Future Directions

Functional Restoration for Neurological Trauma: Current Therapies and Future Directions

Posttraumatic Epilepsy

Memory, Cognition and Consciousness

Depression

Spasticity

Pain

Robotics and Brain--Machine Interface

Conclusions

References

Special Considerations

29 Pediatric Neurotrauma

Epidemiology

Injury Classifications: Injury Type, Mechanism, and Severity Interactions

Pediatric Considerations in Acute Assessment and Management

History

Initial Resuscitation

Neurologic Assessment

Imaging

Spine Evaluation

Risks Associated with Sedation

General Algorithm for Tailored Acute Triage and Initial Management

Communication Among Team Members/Specialties and Families

Specific Injury Scenarios—Recognition, Acute Management, and Pitfalls

Brain Death in Children

Outcomes

Summary

References

30 Care of Patients with Burns and Traumatic Brain Injury

Introduction

Patterns of Injury

Primary Survey

Wound and Extremity Care

Effects of Thermal Injury on the Brain

Aeromedical Evacuation

References

Index

 

An aparitie	2017
Autor	Ecklund
Dimensiuni	18.59 x 2.44 x 26.47 cm
Editura	Springer
Format	Hardcover
ISBN	9783319402062
Limba	Engleza
Nr pag	358