critical care in neurology presentation.pptx

neurocriticare

1. Critical care in Neurology Dr.Sunil Katkade, MD,DA. CEO & Anesthetist CEO, Solaris Hospital, Thane.

2. Neurocritical care Specialized branch in medicine- treating critically ill patients with neurological diseases. Neurocritical care involves the continuous monitoring of intracranial pressure, cerebral perfusion pressure, oxygenation, and other vital parameters. It also includes the administration of medications to control brain swelling, manage seizures, and optimize cerebral blood flow. Additionally, neurocritical care teams may perform invasive procedures such as placing intracranial monitors, draining cerebrospinal fluid, or performing emergency neurosurgical interventions.

3. Team of Neurocritical care ICU. Intensivist Neurosurgeon Neuro physician General physician Nursing Physiotherapist/ Rehabilitation Pathology CT scan, MRI & all the branches of Radiology.

4. Patients requiring Neuro critical care Neurology - stroke, Transient ischemic attack, Myasthenia Gravis etc. Neurosurgery- Post operative, pre-operative, Trauma. Pediatric- all age group patients.

5. Neurocritical care- pre hospitalization Prevent hypotension- intravenous fluids, blood transfusion, inotrope drugs . Prevent hypoxia-oxygen, intubation, artificial respiration. Prevent aspiration- suction. Avoid raised intracranial tension.

6. Raised intracranial Tension. Treatment Elevate the head of the patient. Hyperventilation. Mannitol or hypertonic saline Craniotomy or V.P. shunt

7. Pre-existing diseases & their control Diabetes. Hypertension. Ischemic heart disease. Renal diseases. Respiratory disease.

8. E.C.G. changes in raised intracranial tension Bradycardia. Irregular pulses Tachycardia Raised blood pressure. Neurogenic pulmonary oedema-

9. Maintenance of hemodynamic stability and optimal cerebral perfusion pressure (CPP) are crucial to the treatment of patients with intracranial pathology . .

10. Know your drugs & parameters. Serum Sodium- Trend of Serum Sodium Mannitol. Propofol . Level o f Consciousness. Mean Blood Pressure. Anti-epileptic medications. Adequate pain killers- narcotics, analgesics etc.

11. Intubation & Extubations must be smooth . Intubations are difficult in some of the patients. The intubations must be smooth – use video laryngoscope, bougies etc. Extubations must be smooth with good trials.

12. Plasma exchange for Myasthenia Gravis. Plasma is the liquid portion of the blood. Patients are connected intravenously to dialysis machine that withdraws blood, eliminates the antibodies in the plasma that are causing the autoimmune attack, and then returns the “cleaned” plasma and other blood components back to the body . Plasma exchange can offer a quick improvement in muscle strength—usually within a few days of treatment.

13. Ventilators. Neuro ICU is well equipped with good quality od ventilators. All the modes of ventilators are available. Monitoring of Arterial Blood Gases, ECG, Blood Pressure & other parameters must be done accurately.

14. Seizures monitoring. Seizures monitoring is done. Camera monitors the activities of the patients, including seizures etc. 14

15. Thank you