Emergencyneurology is a complex and rapidly changing field. Its evolution can be attributed in part to increased imaging options, debates about optimal treatment, and simply the growth of emergency medicine as a specialty. Every year, a number of articles published in emergency medicine or other specialty journals should become familiar to the emergency physician.
Abstract: EmergencyNeurologic Life Support (ENLS) is an educational program designed to provide users advisory instructions regarding management for the first few hours of a neurologicemergency... Certification and training in ENLS is hosted by the NeurocriticalCare Society... Keyword: Neurocriticalcare. Keyword: Resuscitation.
Abstract: Acute ischemic stroke is a neurologicalemergency that can be treated with time-sensitive interventions, including both ... For this reason, acute ischemic stroke was chosen as an emergencyneurological life support protocol... hour of medical care following the acute onset of a neurological deficit Keyword: Emergencyneurologic life support... Keyword: Neurocriticalcare.
The need for a systematic evidence-based approach to the care of severe TBI patients within the emergency setting has led to its inclusion as an EmergencyNeurological Life Support topic. This protocol was designed to enumerate the practice steps that should be considered within the first critical hours of neurological injury from severe TBI.
Subarachnoid hemorrhage (SAH) is a neurologicalemergency because it may lead to sudden neurological decline and death and, depending on the cause, has treatment options that can return a ... be life-saving in the first few hours after onset, SAH was chosen as an EmergencyNeurological Life Support (ENLS) protocol.
Because of the value of early recognition and treatment, meningitis and encephalitis was chosen as an EmergencyNeurological Life Support protocol... are crucial steps in the treatment of these patients, as is rapid treatment with anti-infectives and, in some cases, corticosteroids Keyword: Emergencyneurologic life support... Keyword: Neurocriticalcare.
... to detect easily remediable causes, prevent ongoing neurologic injury, and determine a hierarchical plan for diagnostic tests, treatments, and neuromonitoring. Coma was chosen as an EmergencyNeurological Life Support protocol because timely medical and surgical interventions can be life-saving, and the initial work-up of such patients is critical to establishing a correct diagnosis Keyword: Coma... Keyword: Neurocriticalcare.
... experience suggest that early and aggressive treatment of SE improves patient outcomes, for which reason this was chosen as an EmergencyNeurological Life Support protocol... as accelerated second line anticonvulsant drugs and induced coma when these fail, coupled with admission to a unit capable of neurologicalcriticalcare and electroencephalography monitoring.
... Cardiac arrest is the most common cause of death in North America. An organized bundle of neurocriticalcare interventions can improve chances of survival and neurological recovery in patients who are successfully resuscitated from cardiac arrest. Therefore, resuscitation following cardiac arrest was chosen as an EmergencyNeurological Life Support protocol... Keyword: EmergencyNeurological Life Support. Keyword: Neurocriticalcare. Keyword: Prognosis.
... neurological events that require immediate recognition and treatment to prevent irreversible injury and death. As in cardiac arrest, a brain code mandates the organized implementation of a stepwise management algorithm. The goal of this EmergencyNeurological Life Support protocol is to implement an evidence-based, standardized approach to the evaluation and management of patients with intracranial hypertension and/or herniation.
Furthermore, intubation, ventilation, and sedative choices directly affect brain perfusion. Therefore, Airway, Ventilation, and Sedation was chosen as an EmergencyNeurological Life Support protocol. Topics include airway management, when and how to intubate with special attention to hemodynamics and preservation of cerebral blood flow, mechanical ventilation settings and the use of sedative agents based on the patient's neurological status.
Urgent laboratory tests and neuroimaging are needed to confirm the diagnosis. Because acute weakness is a common presenting sign of neurological emergencies, it was chosen as an EmergencyNeurological Life Support protocol. Causes of acute non-traumatic weakness are discussed here by both presenting clinical signs and anatomical location. For each diagnosis, key features of the history, examination, investigations, and ...
Neurological and Central Nervous System Diseases (1) Muscle Weakness (1), Nervous System Diseases (1), Respiratory Failure (1), more mentions
Traumatic spine injuries (TSIs) carry significantly high risks of morbidity, mortality, and exorbitant health care costs from associated medical needs following injury. For these reasons, TSI was chosen as an ENLS protocol. This article offers a comprehensive review on the management of spinal column injuries using the best available evidence. Though the review focuses primarily on cervical spinal column injuries, thoracolumbar injuries are briefly discussed as well. The initial emergency department (ED) clinical evaluation of possible spinal fractures and cord injuries, along with the definitive early management of confirmed injuries, are also covered.
... and early management of several specific issues such as blood pressure, coagulopathy reversal, and surgical hematoma evacuation for appropriate patients. ICH was chosen as an EmergencyNeurological Life Support (ENLS) protocol because intervention within the first hours may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently Keyword: Blood pressure. Keyword: Coagulopathy.
Bowel and bladder dysfunction and neck or back pain may also be part of the clinical presentation, but are not uniformly present. Because interventions are critically time-sensitive, the recognition and treatment of SCC was chosen as an ENLS protocol Keyword: Compression. Keyword: Emergencyneurologic life support. Keyword: Neurocriticalcare. Keyword: Spinal cord. Keyword: Spinal cord injury.
Immune System Diseases (1) Spinal Cord Compression (2), Multiple Sclerosis (1), Back Pain (1), more mentions
Abstract: The appropriate use of medications during EmergencyNeurological Life Support (ENLS) is essential to optimize patient care... pharmacokinetic and pharmacodynamics characteristics, advantages and disadvantages and clinical pearls of these therapies, providing practitioners with essential drug information to optimize pharmacotherapy in acutely ill neurocriticalcare patients Keyword: Adverse drug event.
Few studies have examined bouncebacks to the neurointensivecare unit (neuro-ICU), and we sought to design and implement a quality improvement pilot to reduce that rate ... should become standard of care.Patients at high risk for bounceback after transfer from the neuro-ICU can be identified using a simple tool.
Cardiac Arrhythmia (1), Respiratory Failure (1), Hypotension (1), more mentions
BACKGROUND: Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one spontaneous breathing trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H2O pressure support and 5-cm H2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT.
METHODS: This is a retrospective analysis of intubated patients in a neurosciences intensive care unit. All eligible patients were initially challenged with ZEEP SBT. If failed, a 5/5 SBT was immediately performed. If passed either the ZEEP SBT or the subsequent 5/5 SBT, patients were liberated from mechanical ventilation.
RESULTS: In total, 108 adult patients were included. The majority of patients were successfully liberated from mechanical ventilation using ZEEP SBT alone (82.4%; p = 0.0007). Fifteen (13.8%) patients failed ZEEP SBT but immediately passed 5/5 SBT (p = 0.0005). One patient (0.93%) required reintubation. We found high sensitivity of this extubation algorithm (100; 95% CI 95.94-100%) but poor specificity (6.67; 95% CI 0.17-31.95%).
CONCLUSION: This study showed that the majority of patients could be successfully liberated from mechanical ventilation after a ZEEP SBT. In those who failed, a 5/5 SBT increased the successful liberation from mechanical ventilation.
... were vastly different than what is considered routine by today's standard. This is particularly true in neurocriticalcare patients... This narrative review will discuss current controversies with SUP as they apply to neurocriticalcare patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.