Prognostication in Neuro Disasters

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Oli Flower discusses the tricky issue of prognostication in neuro disasters. This includes intracerrebral haemorrhage, traumatic brain injury, subarachnoid haemorrhage and ischaemic stroke. From Bedside Critical Care 2013 in Cairns. Go to Intensive Care Network for the audio and much more.

Santé & Médecine

PROGNOSTICATION!
AFTER!
NEURO!
DISASTERS

ABOVE OR BELOW THE TENT

photo by Michael Matti

84M!
GCS 7!
80 ml ICH!
Basal ganglia bleed!
Some IVH!
Mild cognitive impairment

72F!
GCS 10!
20 ml ICH!
Lobar bleed!
No IVH!
No cognitive impairment

Australia!
37M!
GCS 3!
Pupils reacting!
No hypoxia or hypotension!
Isolated TBI!
CT with petichial haemorhages,
mass effect 3rd ventricle
compressed, no SAH, no MLS!
BGL 7.0 Hb 8.8

photo by Keoni Cabral

DISABILITY CAN BE HARD TO MEASURE

H
H

1

Asymptomatic, mild headache, slight nuchal rigidity

2

Moderate to severe headache, nuchal rigidity, no
neurologic deﬁcit other than cranial nerve palsy

3

Drowsiness / confusion, mild focal neurologic deﬁcit

4

Stupor, moderate-severe hemiparesis

5

Coma, decerebrate posturing

Grade

GCS

Motor deﬁcit

I

15

-

II

13-14

-

III

13-14

+

IV

7-12

-/+

V

3-6

-/+

So this means.....?

photo by Leo Reynolds

photo by Leo Reynolds

ANAEMIA

HYPERGLYCAEMIA

ICU COMPLICATIONS

LOW VOL CENTRES

The patient and family understand the
potential risks and beneﬁts of therapy

ICH SCORE FUNC!
TBI IMPACT CRASH!
SAH WFNS!
CVA NIHSS

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