Intensive Care for Neurological Trauma and Disease

Barth A. Green, Lawrence F. Marshall, T. J. Gallagher, Barth A. Green, Lawrence F. Marshall, T. J. Gallagher

• Publisher: Academic Press
• Year: 2013
• Print ISBN: 9780127882840
• eBook ISBN: 9781483273716
• Topic: Medicina
• Subtopic: Medicina interna y diagnóstico

Intensive Care for Neurological Trauma and Disease presents the progress in intensive care in terms of technological development on life-support and monitoring systems. This book discusses the ideal neurologic intensive care environment that is based on developments in other specialized care units. Organized into 24 chapters, this book begins with an overview of the problem of neurological trauma. This text then presents the accident scene management protocol for acute spinal cord injury as a standard to other forms of trauma system pre-hospital care. Other chapters consider the appropriate drugs and dosages for the management of status epilepticus in the newborn and older children. This book discusses as well the findings on the neurological examination and provides a framework for an etiological classification that has direct therapeutic implications. The final chapter deals with the clinical aspects, diagnosis, and management of neuromuscular diseases. This book is a valuable resource for clinicians and intensive care unit nurses.

Emergency Medical Services and the Pre-Hospital Care of Spinal Cord Injuries

Barth A. Green, M.D., K. John Klose, Ph.D. and James T. O’Heir, Barth A. Green, M.D., K. John Klose, Ph.D. and James T. O’Heir, Department of Neurological Surgery, University of Miami School of Medicine, Fla.; This work is supported in part by the National Institutes of Health, NINCDS #NS14468 and Rehabilitative Services Administration #13-P-59258.

Publisher Summary

This chapter presents specific guidelines for the identification and management of spinal cord injuries from the moment of trauma until the arrival at the first receiving hospital. It has been well documented that the first moments, minutes, and hours are most significant in the eventual neurological outcome of each patient. The chapter also presents an introduction to the general concept and constitution of emergency medical services in the United States. It provides a brief overview of the problem of neurological trauma. The chapter discusses the accident scene management protocol for acute spinal cord injury as a model to other forms of trauma system pre-hospital care and also presents pre-hospital assessment forms for spinal cord and head injury.

Objectives

1. To present an introduction to the general concept and constitution of Emergency Medical Services in the United States.

2. To present a brief overview of the problem of neurological trauma.

3. To present the accident scene management protocol for acute spinal cord injury as a model to other forms of trauma system pre-hospital care.

4. To present pre-hospital assessment forms for spinal cord and head injury.

Introduction

Modern Emergency Medical Services in the United States evolved as a result of the now-classic white paper, “Accidental Death and Disability – The Neglected Disease of Modern Society,” released by the National Academy of Sciences – National Research Council Committee on Shock and Committee on Trauma in 1966. This document drew attention to the severe deficiencies existing in emergency medical care and served as a catalyst for a series of events directed toward the improvement of the care of trauma victims. It stimulated passage of the National Highway Safety Act of 1966 and the Emergency Medical Services Systems Act of 1973.

By far, the most important legislation regarding Emergency Medical Services was the Emergency Medical Services Act of 1973 (PL 93-154) and the amendment of 1976 (PL94-573). This statute, as amended, instructed the Department of Health, Education and Welfare (DHEW) to designate a lead agency, the Division of Emergency Medical Services (DEMS), to provide program administration, technical assistance, informational programs, award grants and coordinate an interagency committee on Emergency Medical Services. Further, it provided the mechanism and funding for communities to develop their own Regional Emergency Medical Services delivery systems.

Emergency Medical Services Systems center around the 15 components identified by Congress in the Emergency Medical Services Systems Act. These components are:

1. Manpower

2. Training

3. Communication Systems

4. Transportation

5. Facilities

6. Critical Care Units

7. Public Safety Agency Utilization

8. Consumer Participation

9. Accessibility

10. Patient Transfer Mechanisms

11. Coordinated Medical Record Keeping

12. Public Information & Education

13. Independent Review & Evaluation

14. Disaster Planning

15. Mutual Aid Agreements

These components, therefore, provide Emergency Medical Services physicians, planners and administrators with specific organizational structures and evaluation mechanisms. In addition to these components, seven critical patient groups have been identified and include:

1. Major Trauma

2. Burn Injuries

3. Spinal Cord Injuries

4. Poisoning & Overdoses

5. High-Risk Infants

6. Acute Cardiac Emergencies

7. Behavioral & Psychiatric Emergencies

These seven groups were selected, since they represent the major categories of emergency medical problems. They are also easily identified and useful in planning operational and evaluation models. These “most critical’ patients benefit from a systems approach that addresses their specific requirements. The systems care developed for these categories may then be applied to other emergency patients with injuries or illnesses of a less severe nature or those more difficult to identify.

As for the future, it has been proposed that ten centers be established, one in each of the major DHEW regions. These “centers of excellence’ typically would be situated in a major medical center and would be responsible to:

1. Describe and establish the dimension and parameters of EMS problems in a variety of settings: rural, metropolitan, wilderness.

2. Establish a commitment by the health care delivery and academic community to better understand the EMS problem.

3. Provide input as to better utilization of technology and limited resources.

4. Provide input for improved system development.

5. Provide input into the development of model programs of public education and prevention – the ultimate goal.

The necessity of a continued emphasis on Emergency Medical Services is best described by the following tables:

During the period of August 1964 to January 1973, there were 46,572 combat deaths reported in Viet Nam. Annually, by vehicular fatalities alone, we exceed 8 ½ years of combat fatalities. Accidental injurie...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Foreword
• Preface
• Acknowledgments
• Chapter 1: Emergency Medical Services and the Pre-Hospital Care of Spinal Cord Injuries
• Chapter 2: Emergency Room Management for Neurological Trauma and Disease
• Chapter 3: Intensive Care Evaluation of the Comatose Patient
• Chapter 4: Panel Discussion
• Chapter 5: The Multiple Injury Patient
• Chapter 6: Fluids, Salts and Blood
• Chapter 7: Metabolic Considerations
• Chapter 8: Renal Function Syndromes
• Chapter 9: Panel Discussion
• Chapter 10: Physiologic Basis for Monitoring Cardiovascular Systems
• Chapter 11: PEEP and IMV: Definition and Utilization
• Chapter 12: Surgical Intensive Care Unit Computerized Data Management System
• Chapter 13: Panel Discussion
• Chapter 14: The Pre-and Postoperative Patient Intracranial Considerations
• Chapter 15: Increased Intracranial Pressure: Diagnosis, Monitoring and Treatment
• Chapter 16: Panel Discussion
• Chapter 17: Electrophysiological Recording in the ICU
• Chapter 18: Evoked Responses: Use in a Neurological Intensive Care Unit
• Chapter 19: Cerebral Blood Flow and Metabolism
• Chapter 20: Panel Discussion
• Chapter 21: Head Injury
• Chapter 22: Acute Spinal Cord Injury: Emergency Room Care and Diagnosis, Medical and Surgical Management
• Chapter 23: Cerebrovascular Disease: A Neurosurgeon’s Perspective
• Chapter 24: The Early Management of Cerebrovascular Disease: A Neurologist’s Perspective
• Chapter 25: Panel Discussion
• Chapter 26: Pediatric Intensive Care: General Considerations
• Chapter 27: Pediatric Neurosurgical ICU: Special Issues
• Chapter 28: Pediatric Neurology ICU: Special Issues–Seizure Control
• Chapter 29: Panel Discussion
• Chapter 30: Metabolic Encephalopathy: A Mechanistic Approach
• Chapter 31: Neuromuscular Crise
• Chapter 32: Panel Discussion
• Answers to Self-Evaluation Quizzes
• Author Index
• Subject Index