MLB55

Pt is a 63yo male with a hx of a subarachnoid hemorrhage 30 yrs ago s/p clipping. Pt present early in June with a new Sah, from the same aneurysm. Pt was re clipped on the 16th, stayed intubated for a day or two and was successfully Extubated. Compli...

The guy was well over a 100kg...

We only do hypothermia protocol for pts post cardiac arrest. That is, we cool them down to 91.7 - if that's what hypothermia your talking about. Craniectomy within the first 24-48 hours is what our neurosurgery and neurology teams push for. Did the...

The needle decompression. That's a great question. I'm guessing, since he was pusleless and kept losing his pulse? I just heard the attending say, he needs to be decompressed. And he had a central line placed emergently on that side.??

In our 23 bed neuro icu, we clamp the drain to transduce pressures, position changes, and when we transport the pt.

No I meant 4.5 liters. Not uncommon and not the most I've seen. I've had a patient that required 90+units of products... But that's another story. Her urine out put increased after the lasix and then patient started auto diuresing the next day or so...

Pt is 74 yo with a hx of a parotid tumor that mets to the spine, "kidney insufficiency" (as reported by the patient),baseline cr seemed to be 1.09 and htn. Had a two stage back surgery something like T10 to pelvis. The second stage was aborted X 2 du...

Pts cr peaked the next day at 1.44, she's auto diuresing and cr is back to baseline.

Lasix immediately help here urine output. 400 in about 2 hours. Great input... She was definitely +a few liters since the or and had pulmonary edema on chest xray.

We sent one. I don't remember, serum na was normal though.

Do your guys neuro Icus use sbp or map for goals when say triple Hing. Since cpp is map - icp... Why do we use sbp for goals. I've seen them order keep sbp > 200. So what do you use in Neuro? Sbp or map?

I think everybody feels like this at first. Nobody is truly comfortable until at least there first year. Take this opportunity to provide good care and to be known for the care you can provide. Sick or not. I found in my earlier days the sickest pat...

Have you guys seen when anesthesia hooks up the cvp to the port where you put a triple lumen or swan line through? I think this is a waste of a port and I sort of think not an accurate way to measure cvp. Not that the cvp is the end all be all. Just...

They are hooking it up directly to that white/blue port where the slic or swan would go. We typically put in a tlic and transduce off the distal port. But out of the or, anesthesia transduces off the aforementioned port.

Not the big line of a cordis. The part where you put a triple lumen or a swan. The same place and a mac.

I was only asking about triple H therapy for vasospasm patients. I think we would have better cardiac outcome with the same neuro outcome if we used maps. A lot of times these patients require 5 pressors and inotropes to get the patients sbp to 200....

Great post. Are you a neuro critical care team? Again, it just doesn't make sense when your cpp is calculated via map. The reason I ask is that we have put people on phenylephrine, norepinephrine, vasopressin, and epinephrine to reach ridiculous ma...

I work at very large teaching, level one trauma center and there are a few practices that I have questioned in regards to lines. First one is, two Mac or cordis (introducter) lines inserted into the same IJ during liver cases. I understand the ratio...

In the same vessel?

They are directly superior/inferior of each other. They are indeed in the same vessel.

It was between 60-70ml/hr or unit/hour. Guy it pancreatitis.

The two cordis' are for the OR. We would pull one of them once they got to the unit. I've heard of livers getting 91 liters of blood/fluid during a case. So the benefit of two major lines could be needed, I just think they should be different sites. ...

I have two years Neuro icu experience in a large teaching trauma center in Chicago. I recently started being charge rn as needed, which involves responding to stroke codes. Should I opt to stay in Neuro, or switch to sICU? Obviously my goal is crna. ...

Give them more sedation/analgesia before suctioning

Anesthesia gives "sticks" of phenylepherine, usually for sedation hypotension.