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Emergency Algorithm for Cardiac Arrest during Neurosurgery

Know how to manage cardiac arrest in neurosurgery? How to tackle CPR in prone patients?

This is an algorithm from the RESUS council and the Neuroanaesthesia Society for the management of CPR in neurosurgery patients. It is entirely relevant to Prone patient on ITU with respiratory failure. This advises commencing CPR in prone patents in the prone position and assessing the adequacy of Compressions.

The executive summary at the start tells you most of what you need to know. Its in our sim scenario library where I work- but probably too labour-intensive to simulate for the FFICM 

Guidelines from the Braintraumafoundation in the evidence based management of severe traumatic brain injury. This link is the executive summary with evidence based interventions such as the value of Mannitol or EVD insertion in TBI. The first two tables provide the info on when each intervention is recommended. These guidelines were pre DECRA and Rescue-ICP so you may want to review the literature or summaries at thebottomline

Spinal cord injury basic facts booklet and link to e learning module

This is a layman guide to spinal cord injury including levels and and the basic symptomatology the patient may exhibit. Its only a few pages long and will take a few minutes to read but may be worth it before looking at the American Spinal Injury Association (ASIA)classification of spinal cord injury. 

Follow this link to inSTeP e learning program from the ASIA learning centre that is free. The Anatomy module covers different spinal cord syndromes such as central cord, Brown Sequared, Anterior cord, cuadiaequina and conus medullaris syndrome. Also covered in the spinal trauma section of the ATACC manual, scroll to page 353. 

This ASIA chart should be used to assess for all spinal injury patients after stabilisation and admission to ITU. It allows you to define the motor and sensory level of injury and whether it is complete of incomplete. 

Links to visual guides on how to perform motor and sensory examination in cord injury. Further free e learning on ASIA assessment here. For an overview on the management of spinal trauma read the ATACC manual, scroll to page 353. 

You should have an idea of the assessment and management of the spinal cord injury patient on ITU. 

NECPOD: Subarachnoid Haemorrhage 2013

NCEPOD Report Executive Summary: Managing the Flow. A review of care of patient with Subarachnoid Haemorrhage. 

Has a very useful summary of aneurysmal SAH including the fact that 50% die in the first month, 25% become dependent and only 25% return to previous function. Also contains World Federation of Neurosurgeons grading system and recommendations for improving national standards.

Management of perceived devastating brain injury after hospital admission consensus statement from bodies including the ICS. 12 recommendations for managing this condition. Gives clear guidance that we should if possible admit these patients in critical care. 

Academy of Medical Royal Colleges Diagnosis of Death guidelines. This includes information about diagnosis of death following irreversible cessation of brain-stem function.  

Four Score: Full Outline of UnResponsiveness for the assessment of coma

The Four Score is an assessment method for the evaluation of coma that is more detailed than the GCS and can be performed in the unconscious and intubated patient. It has been validated in intensive care

It incorporates Eye Response, Motor response, Brainstem reflexes and Respiration. Each scored between 0-4. 

National guidelines on prolonged disorders of consciousness

Document from RCP 2013 with clinical guidelines on prolonged disorders of consciousness. Worth skimming the document to know the difference between coma, vegetation state, minimally conscious state, and locked in syndrome as a differential. Also covered nicely in simple terms by NHSCHoices. There is a good flow diagram characterising the different conditions in this article

Neurosurgeon statement regarding preventing delays in time critical transfers

Statement from the society of British neurological surgeons in 2015 in support of the fact that admission to a regional neurosurgical unit for life-saving, emergency surgery should never be delayed. This is hugely topical with a recent coroners regulation 28 regarding a case when this did not occur- see the FICM statement from 2017 here 

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