GI Prophylaxis

Indications:

●Coagulopathy, plt < 50K, INR >1.5, or PTT >2 x control

●Mechanical ventilation for >48 hours

●h/o GI ulceration or bleeding within past year

●TBI, traumatic SCI, burn injury 

●Two or more of the following minor criteria:

• sepsis
• ICU >1week
• occult GI bleeding x >=6 days
• glucocorticoid therapy (>250 mg hydrocortisone or equivalent)

 

Reference:

“Stress Ulcer Prophylaxis In The Intensive Care Unit.” Uptodate.com, 2017. 30 Oct. 2017.

Rapid Sequence Intubation

-consists of simultaneous administration of fast-acting sedative to induce immediate unresponsiveness and a NMBA to achieve optimal intubating conditions, with goal of attaining control of airway in critically ill patient at risk of aspiration of stomach contents.

– limits ICP elevation, preferred method for intubation of patient with elevated ICP

– presence of coma does not justify proceeding without pharmacologial agents, although patient unresponsive, laryngoscopes and intubation provoke reflexes that elevate ICP unless pre-treatment and induction agents are used.

REFERENCE:

ENLS 2017 Airway. Neurocritical Care.

LEMONS and MOANS, Mallampati Score and 3-3-2 Rule

Mnemonics to assess for difficult airways during intubation.

REFERENCE:

ENLS 2017, Airway.

Comparison of oral anticoagulant agents (DOACS + Warfarin)

REFERENCE:

ENLS 2017 Pharmacotherapy. Neurocritical Care Journal.

Mannitol and HTS equivalents

The following volumes of hypertonic solution are equip solar to 1g/Kg of mannitol:

REFERENCE:

ENLS: pharmacotherapy (2017) Neurocritical Care Journal

ICP-Volume Curve

REFERENCE:

Kiwon Lee.  NeuroICU Book.

EEG and CBF Correlation

REFERENCE:

Kiwon Lee, NeuroICU Book.