Tag Archives: criteria

Risk for Cerebrovascular Injury after Blunt Trauma

There are two criteria used to screen patients with blunt trauma of cerebrovascular injury:  the Denver and Memphis criteria
Denver Criteria

1. LeForte II or III fracture pattern

2. Cervical spine fracture or subluxation

3. Basilar skull fracture with involvement of the carotid canal

4. DAI with GCS <6

5.  Near hanging with anoxic brain injury
Memphis Criteria:

1. Cervical spine fracture

2.  LeForte II or III facial fracture

3.  Basilar skull fracture with involvement of the carotid canal

4.  Horner’s syndrome

5.  Neurologic deficit not explained by imaging studies

6.  Neck soft-tissue injury (seatbelt sign, hematoma, or hanging)

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Weaning Parameters

Weaning parameter values typically used to predict weaning outcome

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Hemodynamic and respiratory parameters used to determine readiness for spontaneous breathing trial

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Hemodynamic and respiratory parameters used to determine an unsuccessful spontaneous breathing trial

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Hemodynamic and respiratory parameters used to determine readiness for spontaneous breathing trial in neurosurgical patients

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Reference:

Layon, A. Joseph, Andrea Gabrielli, and William Friedman. Textbook Of Neurointensive Care. London: Springer London, 2013. Print.

NEXUS Criteria for C-spine Injury

N.E.X.U.S. = National Emergency X-ray Utilization Study

Utility:  if criteria fulfilled, low risk for spinal injury and c-spine can be cleared without the need for imaging

NEXUS Criteria:

  • Normal level of alertness
  • Not intoxicated
  • No midline cervical spine tenderness
  • No other painful injuries that may distract the patient from a less painful (but broken) neck
  • No focal neurologic deficits

Only if patient fulfills all 5 criteria – then forego imaging.  Otherwise, proceed with imaging.

Mnemonic: NSAID (neuro deficit, spinal tenderness, AMS, intoxication, distracting injury)

National Emergency X Radiography Utilization Study NEXUS Criteria Emergency Medicine Practice.JPG

 

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Reference:

Hoffman, Jerome R et al. “Selective Cervical Spine Radiography In Blunt Trauma: Methodology Of The National Emergency X-Radiography Utilization Study (NEXUS)”. Annals of Emergency Medicine 32.4 (1998): 461-469. Web.

TOAST Criteria

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References

Adams, H. P. et al. “Classification Of Subtype Of Acute Ischemic Stroke. Definitions For Use In A Multicenter Clinical Trial. TOAST. Trial Of Org 10172 In Acute Stroke Treatment”. Stroke 24.1 (1993): 35-41. Web.

RIFLE Criteria for Acute Kidney Injury

The table below shows the RIFLE (Risk Injury Failure Loss End stage) classification scheme for acute kidney injury.

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This system has a separate criteria for creatinine and urine output.  If the patient’s condition falls under two different levels, then the worse classification should be used.

RIFLE-FC = denotes ‘acute-on-chronic’ disease.

RIFLE-FO = when RIFLE-F classification is reached by urine output criteria only

 

Checklist:  AKI work-up

  • Urinary sediment
  • Urinalysis
  • exclude obstruction
  • review of meds
  • rhabdomyolysis: creatine kinas, free myoglobin
  • vasculitis: CXR, blood smear, measurement of nonspecific inflammatory markers, specific antibodies (anti-GBM, ANCA, anti-DNA, anti-smooth muscle)
  • TTP: LDH, haptoglobin, unconjugated bilirubin, free hemoglobin
  • Cryoglobulins
  • Bence-Jones proteins
  • Renal biopsy

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References

Bersten, Andrew D, and Neil Soni. Oh’s Intensive Care Manual. London: Elsevier Health Sciences UK, 2013. Print.

Pleural Effusion

Diagnostic Criteria (1 of 3 for exudative)

PF protein / serum protein >0.5

PF LDH / serum LDH >0.6

PF LDH >2/3 upper limit of normal LDH

DIC

Disseminated Intravascular Coagulation Scoring System

dicscore ISTH Scoring System

 

TREATMENT:

  • no specific treatment other than that directed against predisposing condition
  • bleeding – replace platelets and coagulation factors
    • cryoprecipitate 10 units = fibrinogen 2.5 g  –> but this rarely helps, consumption of platelets and coagulation proteins can aggravate thrombosis
  • heparin is ineffective in retarding microvascular thrombosis (due to depletion of antithrombin III)
    • give heparin with AT-III? – 90-120 units load then 90-120 units daily x 4 days (no evidence for improvement in mortality)

 

References:

Marino, Paul L, and Kenneth M Sutin. The ICU Book. Philadelphia: Lippincott Williams & Wilkins, 2007. Print.

Kiwon Lee.  NeuroICU Book