When does Primary become Secondary Injury?

On scene ED NCCU

Secondary brain injury occurs after the primary mechanisms of injury have run their course (Gennarelli & Graham, 2005)

Secondary brain injuries often result from complications of the primary mechanism of injury and may occur anywhere from hours to days after the initial injury (Dawodu, 2007)

So at best

Neurocritical Care will only save neurons that have not died

NCCU Has 3 functions

Maintain Airway Good Nursing Care Weaning from Ventilator

A S S O O N A S W E G E T I N V O LV E D W E C A N E A S I LY D O H A R M

utter cluster fxxx /

abject harm

perfect care

/ good outcome

The Spectrum of Neuro Critical Care

The good perfectionist

The bad perfectionist Nature

Where most of us practice

{

BUT WE MUST STOP SECONDARY INJURY….

Like Hypotension?

BUT WE MUST STOP SECONDARY INJURY….

Like ICP?

HYPERVENTILATION1982 Good 2002 Bad

C O O L I N G

J U G U L A R V E N O U S S AT U R AT I O N

Who regularly does this?

B R A I N O X Y G E N AT I O N

B R A I N O X Y G E N AT I O N

So we await….

S T E R O I D S

2004 Bad1985 Good

N E U R O P R O T E C TA N T S … .

N T E R V E N T I O N S T H AT D O H E L P

e.g. Dialysis

….But these are not NCCU specific

N T E R V E N T I O N S T H AT D O H E L P

e.g. Antibiotics

….Probably don’t need ITU

The Time to Save neurons is BEFORE Neurocritical care

Once there… In the spontaneously breathing patient…

than NOB THERAPYIs all this really better

Ventilation Art Line

Central Line Vasopressors

ICP Licox

Microdialysis TPN

Tracheostomy

Neurocritical care is no better than

W H AT H A P P E N S I F

S H O W S D E C O M P R E S S I O N B A D ?