Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Uh, hello. I am feeling a little on the soles here in the calls way. Thanks for joining him today. Welcome, Tender on his lesson. I'm not going to die before. Loss of information wants to take in. Uh, so today what I want to focus whole is traumatic brain injury management, CBI for short, uh, patients who present our department. Especially hand. If the Northwest 200 I will touch on brief like primary, second brain injury. How we manage a resource. That way we manage it the way we don't based all this. Doctor, my one True Kelly. So what is primary brain entry? It's basically the initial insult from that, then tired itself. So whether it be were cyclists to trade roof from the accident fall 20 ft for a ladder. The initial injury to the brain is for Brian MRI breathing been three. It's not much we can do about it here. What's what people can do is try to avoid these things where helmets drive safely. That was two things. Our key thing here and any is to try to prevent a second rate breathing through that curse following the primary and dry others things that could happen. Agreeable? That's injured. It could have been like physiological, uh, dysfunction on. If we can try to minimize such on, get the brain the best I can with the patient asked. I come, that's we've got our joke. Mail, like with patients, bring intragenic. Just starts in an E. I, of course that but the whole hospital Germany have them. But if we could try to get it right turning doors, the chances are these patients will have a better. Okay, So, like all results, trouble patients, we fold agent as political. Additionally, this traumatic brain injury patients we really want that was on there may make sure they have a definite army early doors, especially if they have a significant sexual trauma on the injury. Where bloods fluid form always together on there really lost very quickly Want. Make sure there will also need a breathing on. These patients need to have good blood flow, whether by increasing the flu or blotch so that they don't give in to hypertension happens Alinia. So the brain doesn't like that again with these patients have head injuries and, uh, drawing DCs when they take their Sinuses. Talk about today burning your most lamp. It essential. So specifically in these patients, I focus neuro exam on documentation of the scene. Pre integration. Pretty hospitalization is okay. Uh, good hand in hand exam. It's crucial that New Form Boyz hiding in there and sculpt. How about the rise? Do they have a period for peri orbital breathing bruising behind their ears is there, See, is that for blood leak from their nose or their years? So I'm not going to hurt. I really miss important if they're still get the CT dancing three. So expressions. Okay, thanks. Have a white are hypoglycemia hypertension type of leukemia. Hypertension on reas icy pain. I want to focus is not from next couple flights here was reassigned CP. Okay, so one rule Kelly doctrine. This feels the job from these two guys two centuries ago. Come up with this idea that under normal conditions, the total volume in the skull is constantly this is treating Today will be so the brain tissue, the cerebral spinal fluid on the block Oh, got it together equals the intracranial pressure night for intracranial pressure. Teo really? In a good level on a line going to be probably perfused That usually says here in 60 millimeters, which don't pay too much attention to that. But that's the normal value that were even for right. Three. Blood flow is regulated by the brain itself. Plans the brain could regulate it to a certain level. After that, it becomes overwhelmed on things. Start to die. I wish so the mineral Kelly don't from tells us that intracranial pressure is that some of these things together the breathing is in a box. It can expand. Uh, right. It's constant to the brain and help the brain itself regulates the pressure to make sure that and healthy adult size good, not feel off. So if one of those parts is injured, say there's lots there's they have one of the other compartments won't have to compensate it Decrease to prevent the intracranial pressure from rising night. That could happen on this anti a certain level. There certain level of compensation After what ship the intracranial pressure rises. 15 2025. If it's going up much, they work in decompensation. Longin was bringing then start to go off. So, I said, are extremely perfusion pressure. Uh, 1. 69 million workers accept it on T company that it's the mop may just a simply Masamune are single pressure. ICP is incredible pressure. Not here. Suchiate. Dependable natural patient and a traumatic brain injury push. It's the mop. Let's get a higher level. I cypionate to know to ensure the brain that smell perfused. I know. Let's leave that lot. She terms of medical jargon, and it's okay if you don't get that. My biggest point is if there's an injury to the brilliant, the pressure and sighing to come quickly. Rice hard to be recognized that and are any department great Nice notch. Three different sciences symptoms changed in the patient's mental status. SEC headaches that I haven't more Remove mints, the purposes movements, people's Concerta size. Then they start to have seizures. GCS girls Very, very a signs are this thing called Cushing's Try out? Try an MRI. Three. They develop white calls pressure. They're hard, It slows down. The breaking slow becomes about it. That is a little now. As I said before, the green is in a closed box. Where else can I go with The pressure? Gets too much but don't work. So that's a thing called come in where? Bring in the green. Stamps start to move during March 3 on or if it's the least the brain called around on the Creon. Specially through that stand, you got a face of the breathing. Really? Carby it. The cranial nerves start. Right? Um, this patient is having death. That's nothing. Still Okay, So began in an e. Keep things. We live alone. Been a patient with the traveling breathing? Wasn't you know it is the pressure, the insurance of them, the level about the right level. Teacher perfusion pressure right. Guided by the doctors. Are there insured patients? Temperature is in the normal. Normal for me? A. They sure they are well, all she did delete it. That's elevated to 30 degrees. Sometimes these patients will have, like COPD and city. No, these were patients are called me and yeah, busy on the Royal. And I see four monitors and we'd really not really off about. But it's important to know it's it's interesting to know whether whether it's trying to form their nose. No, but it's interesting to know that sometimes monitoring the intracranial pressure could be done invasively like this weather. There's a dream and certain into the ventricles, which can control the pressure another way. Okay, but for the principal off this talk uh, teo yourselves way, you need to just keep in mind. No pressure. The temperature. Make sure they're well. See, that's on. But we can tell that they had upper 70 30 degrees. So apply, not know is something just told about that theory to use. Let's think about it. This 44 45 year old motorcyclist, who's ejected from his bike and then in my eyes in testing paramedics have my lesson. All it's a trauma to present happened happened on Earth. It on Just hold first discussion. He has visual trauma. He's combative, confused is hypertensive and tachycardia. He was wearing his How long the letters saying There's been no other obvious injury. Okay, so just think about this patient. What were we doing next? I think that this point I'd like to emphasize the importance off over by far is it? If there's no chip emergency in that next 13 minutes, then I should be really handle groups think that all here with prominent sitting, first of all, thinking about with partner, has just called three participation out for us and 100 100 patients. Um, we need to respect the handover. Let's see lesson care for There's so many crucial points to learn from 100 on. If you started talking patient, I think then you could start to lose concentration of what's been said so again, part medics are crucial in this management. Also, they also have other vitamin prevention which might know kind of adjust the time So it's important to have a child. Then later, later, two shots after during or around the time off. The patient been knowledge to get me out of information. For example, in one of my cases recently, I was told, after especially had taken cocaine, which could have think that their heart rate and BP on there about combativeness. So the most important information that he might just know again in the 100 for on the harmonics hold the key. So listen to respect them on get them the time, just just like don't talk over. Okay, so this keeps we come back. Suspect. It's swollen and it's gonna be major. Is she, especially the kebabs Try to manage us. Explain about patients could be very difficult. So I think the next stage is Robert Sequence induction into it until it a dress. By doing that, the hyperflexion cell cell, um, control the green. Nice way to make sure bring in a, well, perfused well, washing. It was like over oh, shit. Needing the patient. So that's that's a little more thing to think about it. Uh, from the medical perspective, I think construction actually just custom in the back. It's not green. So this patient, she says record US 13 underwent possible indication. Under used are taking the melts procedure. Yes, we've talked about earlier today on then the C spine car That's safely apply it, uh, point again, not too tight, because that can affect that internal pressure. CS pre intimidation don't retention. Really important. Pretty healthy, though we need to know what's actually see us before that. So so she determined. Essentially high. Well, if you get the patch, not there at the end of this journey, predict it comes. Uh, what's the third? GCS is less the night pre insulation. It's suggested this is gonna be a her like, but they're extremely they're excuse. So primary is a concern. Become be still incomplete pass a patient has needed to international period Probably started progressively address second drink that is always dressed at that point, and we completed even for patients. Actually, they're not going to make sure you're not missing any other injuries that can develop in time with this patient Protector has interviewed. It should always be checking people's. Make sure that they're still reacting support to know that makes it is given politics medications that paralyzes people will still check for any sort of waiting. Do your headaches on again? Um, if they're stable, normal their major injuries you see over blood loss, then no, for city, I think, because I think the point of me off the brain family think about handling where these injuries concur. Uh, so just briefly looking up the layers of the off the skull from the skin doing that, all these fancy new ones to get home because that skin to go globe on their streamy in layers surrounding the brand Jeremiah Journal matter, arachnoid matter pee and other. Between each of those matters, you should get blocked. You can get it likes that pressure, said You're a monitor. Every journal subdural. That's the blood clots either above or below the jurors. Southern Illinois isn't something just be a hemorrhage. Hemorrhage come in, cause blockage to the flow off the strippers. Flute my face. All these patients tend to development hydro cath less on needing dreams. Scribble Contusions are basically bruises when the brain causing anywhere bring justice. Excell injury is from a major trauma to the brand major force applied on the drone's within the green, deep in the brain or damaged No on the skull fracture. Girls apart interest me that so are is educated. They want their CT. They had a small stroke. Journals, journals again. They're below the jurors on because of that, then they form this crescent. She ever went the brain on scan clots. Several clots form with present ships, as opposed to the epidural little form of lands shipped clot and artists. And your surgeons did not get all This is all the the scan of our patients. By the way the patient did not get the news is, however, it did not, uh one. Patients. There was no impending herniation. That's a cleaning cooking better there. The clot was too small. Trip or inquire again on their house and she says, My point, the compression. So they transferred out. I see a on under the surgeons. Okay, so just a couple of slides on I CPA intracranial pressure that that's right night. This is beyond us and results, but I think that they were understanding why security keep an eye on, especially in the Royal like CEO. Yesterday's had intracranial pressure. Monitor insurgents on what? What? How so, basically. But then the pressure should last 20 years. Show the brain well, perfused. If the pressure structure Nice, then the doctor should inform immediately. Come to that site. Examine the patient. Do the basics. The neuro exam exciting for signs of herniation. We talked about earlier that by it pulls pressure the body cardio the right your breathing check for affects people. If there's any of those signs, patient needs to be brought back to the CT scanner on your church, you take every vault. So what happens then? If I see treated, pressure keeps rising on the monitor. Elevate they had that morning. Don't, uh, they're sedation, or it's easier to just the other needing. Reacting the bone ever had tea and maybe becoming less depressed the nurse because I consider a dream and extra for your treatment today, which is a ventricles stream else. A little X is 2% reduction. Go through this little pathway, the because of a summary of hemorrhage so we can't get dream. Probably bring Piper Kerman C lion, Sylvanus. That's all right. See a cycle in two days. Try to just swim and swelling and we're just increasing pressure. Drawing fluid right with us. Really high pros. More solution is an intermittent bulls, 3% 3 miles per kilo over 10 minutes. Else that could be given go on a Q tip and pulling me it's was a small diuretic, but again, with cancelling on who may already be so the they're just extras inside it. 10 for everybody to understand why I told it right here. But it's just what happens in our I see he's on these patients who become surely worse so that continues to rise to spy owns. Attempt to try to stand up from going any further. Uh, they can be said that we consider for the press is pretty good. Okay, uh, if they are clean, that's what's happening. Aggressive type of the election consultants be applied to try to just the blood flow to just the pressure. We're just next biggest in the brain. Forget because of bowls of politics, but say it's very grand, but this is How about this is a stage of it. Okay, so, yes, that's a lot of information that we've covered there today. Hopefully, you could take some of those things like high. Well, how important the basics are. Traumatic brain injury. Monitor the BP, managing the oxygenation. Keep make sure that it's temperature is well controlled with a good understanding You trying to prevent sangria brain and drink on. We know what's right for terms of the rising signs and symptoms. It's a consult pressure. I hope that has given song confidence in Montana. Patients moving forward. Um, again, Thanks for much for taking the time to listen to him today. I'm happy to answer any questions on the floor, but when this talk, uh, discussed here today, thanks again by by