This position statement from the Neurocritical Care Society advises on what to do when faced with a patient with a devastating brain injury (in practical terms it relates to those patients for whom neurosurgery is not carried out). The gist is that early prognostication is not the right thing to do and that such patients should be admitted to an ICU (not necessarily a neuro-ICU) and reassessed over a period of up to 3 days. The rationale is that early prognostication is unreliable (this review gives some background) and that by withdrawing life sustaining treatment we would be denying a real chance of life with full neurological recovery.
I picked up this paper as a local news story rather than because of its content - it was written by our local neurosurgical research group. Turns out it was very interesting, but not for the reasons I thought it might be..
One of our simulation scenarios involves treating a head injured patient. Just before we leave to get into the ambulance, the pupils become fixed and dilated. We then discuss whether to transfer the patient or not, with all groups to date feeling that yes, we should. But what is the prognosis for patients with bilateral fixed dilated pupils (BFDPs) after an acute extradural or subdural haemorrhage?
Two papers for your perusal this month, each looking at throwing all medicine has to offer at two diseases with potentially awful outcomes – cardiac arrest and ischaemic stroke.
The TTM trial is important for several reasons. Firstly, by instituting therapeutic hypothermia you will be subjecting the family of the patient to an increased period of uncertainty about neurological outcome and for that you need to believe the intervention is beneficial. The second reason you should know about this trial is that other people do – your colleagues in EM, cardiology and medicine will all expect that you have an intelligent opinion about how this paper might change your management.
This is a collection of blog posts written about new research or topics of interest.
This site is written for healthcare professionals. Nothing on it constitutes medical advice, and opinions expressed are those of the authors.
Dr Peter Hersey & Dr Laura O'Connor