maui2413

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. he was cooled to 92degrees his 3rd day admitted because he was showing pupillary changes Craniectomy within the first 24-48 hours is what our neurosurgery and neurology teams push for. Crani/bone flap was done a week later. I'm still trying to figure out why they waited so long? Did the pt have an Evd or bolt? I would assume so with the aggressive care, seemed all measure were given. Paralytics, 3 percent, mannitol - I guess the next step would be pentobarb coma and lobectomy. Did the do a lobectomy? They didn't do a lobectomy. No bolt or EVD I hope the patient wasn't brought to mri with high icps, that could of pushed the patient over the edge... 7/1 The Dr. ordered us to get the MRI done asap, knowing his ICP was in the 20-30s. We did give mannitol before going to MRI. 7/2 After the Crani was done, the hummingbird was removed, the next day we went to CT, so no way of knowing the ICP. 7/3 MRI was again done the day after CT with the hummingbird removed during the crani.

Taking care of a pt for the past couple days and want some advice on what could've been done differently or not, for the sake of learning purposes.... This pt had a TBI, was having pupillary changes 3rd day hospitalized and started on hypothermia protocol...was on it for a week, managed ICP with mannitol q6, 3% drip, and 23% PRN...a week later a crani/bone flap was done to help with the ICP...next day, hypothermia D/C'd, nimbex off, slowly rewarming pt at 7am, cough/gag intact, pt partially blinking, spont breathes, 6pm pt at goal temp. Next day, 7am pupillary changes more and more frequent, MRI ordered, pt starts deteriorating fast.....unable to use previous drips as sodium was critically high. End of shift patient herniates, pupils fixed and dilated, all reflexes lost.