NEUROSURGICAL Basics Audio CD + 248 Page PowerPoint CD for Sale

NEUROSURGICAL Basics Audio CD + 248 Page PowerPoint CD For Sale

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NEUROSURGICAL Basics Audio CD + 248 Page PowerPoint CD:
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Includes the Adobe Acrobat Reader for reading and printing publications.

Numerous illustrations and matrices.

Contains the following key public domain (not copyrighted) U.S. Government publication(s) on one CD-ROM in both Microsoft PowerPoint and Adobe Acrobat PDF file formats:

TITLE: Neurosurgical Decision Making (In Six Parts/Presentions), 248 total pages (slides)

++ Narration embedded in the PowerPoint Presentation (click on the speaker icon to activate)

++ A 79 minute audio CD (will play in any home or car CD player) with the same narration in chronological order.

SLIDE TOPICS and SUBTOPICS:

Neurosurgical Decision Making
LTC Richard Teff, MD
Theatre Neurosurgical Consultant
October 2006-September 2007Core Objectives
Review essential neurological exam techniques
Review practical clinical neuroanatomy
Accurately interpret head CT examinations
Decisively determine treatment strategies using examination and radiological information
Accurately place and use an ICP monitor
Adhere to theatre clinical pathway guidelinesCourse Breakdown
Introduction
The Essential Neurological Examination
Interpretation of the Non-Contrast Head CT
Abnormal CT Findings and Neurosurgical Decision Making
Intracranial Pressure Monitoring
Neurosurgical Clinical Pathway Guidelines
History and Rationale
Neurosurgeons in Baghdad or Balad
Echelon 3 Locations:
Ibn Sina (Baghdad) Mosul
Cropper (Baghdad) Bucca (Um Qasr)
Tikrit Balad
Two groups of patients need more than ATLSPatients Needing Damage Control Neurosurgery
Those who are too unstable to transport
Those who cannot be transported
Military providers must be prepared to triage and treat neurologically injured patients when neurosurgeons are unavailable
End
Neurosurgical Decision Making
LTC Richard Teff, MD
Theatre Neurosurgical Consultant
October 2006-September 2007Parts of the Coma Score
Scalp
Always shave the scalp
Hold pressure on active bleeding
Do not probe exposed brain
Note abrasions and contusionsPupils
Size and Reactivity
Not paralyzed by neuromuscular blockade
Dilated & briskly reactive = chemical paralysis
Dilated & nonreactive = end stage brain injury
Pinpoint = narcotic effects
Unilaterally dilated = intracranial mass effect
Unequal Reactivity = ocular or optic nerveSpine
Cervical, Thoracic, Lumbar, and Sacral
Precautions prevent secondary injuries
Visual spine = intracranial pathology
Quadriplegia = cervical spinal cord injury
Paraplegia = thoracic spinal cord injury
Cauda Equina Syndrome = lumbosacral injury
Monoparesis/monoplegia = think plexusGlasgow Coma Score
Three portions
Eye Opening (1-4)
Verbal Score (1-5)
Motor Score (1-6)
Minimal Score = 3
Maximum Score = 15
Maximum Intubated Score = 11-T
Classifying Head Injuries
GCS 13 – 15 (mild)
GCS 9 – 12 (moderate)
GCS 3 – 8 (severe)
GCS 3 – 5 (expectant)End
Neurosurgical Decision Making
LTC Richard Teff, MD
Theatre Neurosurgical Consultant
October 2006-September 2007IntroductionEnd
Neurosurgical Decision Making
LTC Richard Teff, MD
Theatre Neurosurgical Consultant
October 2006-September 2007Introduction
Classifying Head Injuries
GCS 13 – 15 (mild)
GCS 9 – 12 (moderate)
GCS 3 – 8 (severe)
GCS 3 – 5 (expectant)
Mildly Head-Injured Patients
Glasgow Coma Score 13-15
May have had a seizure
May have been unconscious
Remember: This is a mild head injury
May be managed at Echelon 3
Close the scalp
Monitor the patient
Coalition evacuation category: ROUTINE
Moderately Head-Injured Patients
Glasgow Coma Score 9-12
May be safely monitored
Do not require “reflex” intubation
Remember: I have time
Complete the CT scan and read it
Contact the neurosurgeon and discuss the case
Transport the patient safely
Evacuation category: PRIORITYSeverely Head-Injured Patients
Glasgow Coma Score 6-8
The “keepers”
Failure to manage = Persistent Vegetative State
Remember: Now is the time
Intubate now
Start medical interventions now
If you can, place an ICP monitor or operate now
Evacuation category: URGENTExpectant Patients
Glasgow Coma Score 3-5
Not salvageable unless the neurosurgeon is there
90 day mortality >90%
Remember: Conserve our resources
Preservation = Persistent Vegetative State
Evaluate the patient
Hemodynamically unstable: Palliative care
Coalition evacuation category: PRIORITYCase #1
Iraqi civilian with penetrating head injury
Airway intact
Breathing normal
Circulation normal
Right forehead laceration extruding brain
GCS E3V4M6 = 13
No hemiparesis
Pupils 4 mm/Briskly reactiveFirst Impressions: Case #1
This is a mild head injury
This patient can be safely managed here
I need to close the scalp
I need to consider how I’m going to monitorConclusions: Case #1
This is a mild head injury
This patient can be safely managed here
Close the scalp
Antibiotics and/or Seizure Precautions?
Admit and monitor for 12-24 hours
What if the patient deteriorates?
Case #2
Iraqi soldier shot through the forehead
Definitive airway, chemically relaxed
Respiratory normal
Circulation normal
Forehead penetration and parietal exit wound
GCS E1V1TM1 = 3T
Chemically relaxed with neuromuscular blockade
Pupils Right 2/nonreactive, Left 9/fixedFirst Impressions: Case #2
This is a severe head injury
This patient is probably expectant
If I’m going to intervene, I should do it now
Medical interventions to start now
I need to close the scalp
I need a plan for evacuationConclusions: Case #2
GCS E1V1TM2 = 4-T
This patient is expectant
Remember: Conserve our resources
Palliative care
Coalition option: consider PRIORITY evacuation
Discuss with neurosurgery
Case #3
Coalition soldier, blast to the face
Definitive airway, chemically relaxed
Respiratory normal
Circulation normal
Blast injuries to the right face and orbit
GCS E1V1TM1 = 3T
Chemically relaxed with neuromuscular blockade
Pupils Right globe disrupted, Left 3/reactiveFirst Impressions: Case #3
GCS E1V4M5 = 10
This is a moderate head injury
This patient is going to require evacuation
Key phrase: I have time
Complete the CT scan and read it
Contact the accepting MD and discuss the case
Transport the patient safelyConclusions Case #3
GCS E1V1TM5 = 7-T
This is still a moderate head injury
Remember: I have time
Send the images to the neurosurgeon
Discuss the case with the neurosurgeon
Transport the patient safely
Irrigate, debride, and dress the wounds
Begin antibiotics and seizure precautionsCase #4
Civilian female, gunshot to right head
GCS E1V2M5 = 8 prior to intubation
Respiratory normal
Circulation normal
Right frontal bullet tract with crepitence & brain
Repeat GCS E1V1-TM5 = 7-T
Pupils 4/briskly reactive
First Impressions: Case #4
This is a severe head injury
This patient is a “keeper”
Key phrase: Now is the time
Secure the airway now
Start medical interventions now
Transport the patient nowConclusions Case #4
This is a severe head injury
This patient is a “keeper”
Key phrase: Now is the time
Central venous & Peripheral arterial lines
Intracranial pressure monitor
If no neurosurgeon, damage control operation
If unable, close the scalp and continue medical interventions until the patient can be transportedEnd
Neurosurgical Decision Making
LTC Richard Teff, MD
Theatre Neurosurgical Consultant
October 2006-September 2007Introduction
Codman® ICP Monitoring System
Codman Skull Bolt Components
Optional Cranial Access Kit For Added Convenience
Codman Ordering Information
Calibration TechniqueInsertion TechniqueEndNeurosurgical Decision Making
LTC Richard Teff, MD
Theatre Neurosurgical Consultant
October 2006-September 2007Introduction
JTTS Home and Guidelines for Monitoring and Lab Evaluation
ICP Monitoring All patients GCS 3-8
Arterial Line All intubated patients
CVP Line Advanced medical care
CT Scan Admit and any changes
ABG, CBC Every 12 hours of 48 hours
Chemistry
PT/PTT/INR
Dilantin Level
General Management Principles
Philosophy
IV fluids
Sedation
GI and DVD prophylaxis
Seizure Medical Management Goals
ICP <20 mmHg
CPP >60 mmHg
SBP >90 mmHg
O2 Sats >93%
pCO2 30-35 mmHg
PLT >100,000/ml
INR <1.5
Sodium 135-150 meq/L
Intracranial Pressure Management
Neutral head positioning
Head elevation
Sedation
Fever control
Chemical fluids
Ventricular drainage/decompressive craniectomy
Clinical References
Glasgow Coma Score system
Uncal herniation syndrome
Sodium disorders:
SIADH
Cerebral Salt Wasting
Mannitol use
Diabetes insipidus
Theater Neurosurgery Consultant recommendations
Balad neurosurgery contact informationEnd