Discover and read the best of Twitter Threads about #neurocriticalcare
Most recents (10)
🧵Let's talk hypernatremia
So often we discuss the correction rate of hyponatremia, but what about hypernatremia? #medtwitter #nephtwitter #meded
🧐What is your correction rate for chronic hypernatremia?
So often we discuss the correction rate of hyponatremia, but what about hypernatremia? #medtwitter #nephtwitter #meded
🧐What is your correction rate for chronic hypernatremia?
Older guidelines recommend a correction of no more than 8-10 mEq/dL in 24 hours borrowed from pediatric literature
“Fast” correction is generally considered to be more than 12 mEq/dL per day
pubmed.ncbi.nlm.nih.gov/20412412/
“Fast” correction is generally considered to be more than 12 mEq/dL per day
pubmed.ncbi.nlm.nih.gov/20412412/
There are some cases in which you may tolerate permissive hypernatremia, but the evidence behind its benefits we can discuss another day.
Ahem #neurocriticalcare looking at you….
Ahem #neurocriticalcare looking at you….
1/ Time for another illustrative learning case in the form of a 🧵#tweetorial #medtwitter #neurotwitter #neurocriticalcare #neurology. Case deidentified as always
2/ Young human with no medical history but IVDA (heroin, cocaine, PCP) with multiple prior overdoses and recent discharge from drug rehab 2 days prior who presents to #ED after acting funny
3/They were noted to be lethargic, GCS 13, not able to provide history. CT demonstrates cerebellar edema with #hydrocephalus (💧) and some ⬆️ transtentorial 🧠 herniation 
1. A 57 yo man is brought to the ED after being assaulted. He was hit in the head with a baseball bat. GCS 7 (E2V2M3), R pupil 6mm and L pupil 3mm, both are reactive to light. CT is obtained.
2. TBI is a very common reason for admission in the Neuro ICU. In this #NeurocriticalMedEd Tweetorial we’ll cover:
1. Initial presentation & resuscitation
2. Imaging
3. Initial management
4. The battle against ICP
5. Treatment algorithms
6. Other complications
1. Initial presentation & resuscitation
2. Imaging
3. Initial management
4. The battle against ICP
5. Treatment algorithms
6. Other complications
@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas presenting results @ttm2trial now join the livestream #SCCMSoME cochranelibrary.com/cdsr/doi/10.10… Low numbers, lack of certainty hence need for TTM nejm.org/doi/full/10.10… #CHESTTrainees @neurocritical
@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical Variability in evidence, lack of definitive answer for TTM/clinical equipoise @ttm2trial @WICSBottomLine power calculation based on ARR of 7.5, n=1900. Inclusion: Adult, comatose, cardiac arrest-cardiac/unknown; stable ROSC, no ECMO, not asystole, max time from arrest 180 mins
A #tweetorial #medtweetorial
@MedTweetorials
1/
3 AM: Pager Pager Pager
Me [very groggily]: Hey, what’s up?
Awesome overnight APP: Sorry to wake you! But, Mrs. Very-Small-Stroke-NIHSS-2-Had-Been-Clinically-Stable-All-Day just PEA arrested.
Me [not so groggily]:
@MedTweetorials
1/
3 AM: Pager Pager Pager
Me [very groggily]: Hey, what’s up?
Awesome overnight APP: Sorry to wake you! But, Mrs. Very-Small-Stroke-NIHSS-2-Had-Been-Clinically-Stable-All-Day just PEA arrested.
Me [not so groggily]:
2/
Awesome APP: We successfully got ROSC (bc team
@emoryneurocrit
= Flexed bicepsStar-struck) and have him stabilized. Going to scan now!
So, #neurotwitter, where’s the lesion?
Awesome APP: We successfully got ROSC (bc team
@emoryneurocrit
= Flexed bicepsStar-struck) and have him stabilized. Going to scan now!
So, #neurotwitter, where’s the lesion?
3/
Trick question.
All of these areas through neurologic pathology – stroke/seizure/bleed - could all have caused a sudden death (or at the very least sudden LOC).
Trick question.
All of these areas through neurologic pathology – stroke/seizure/bleed - could all have caused a sudden death (or at the very least sudden LOC).
1/
Your patient that is “over breathing” the vent may still be dead by brain criteria.
A #tweetorial #medtweetorial for providers in #criticalcare #EM #neuro #neurocriticalcare. @MedTweetorials
Your patient that is “over breathing” the vent may still be dead by brain criteria.
A #tweetorial #medtweetorial for providers in #criticalcare #EM #neuro #neurocriticalcare. @MedTweetorials
2/
First and foremost, let’s be clear that to be dead by brain criteria, the patient must have cessation of ALL brain function *INCLUDING absence of respiratory drive.*
Thinking "But... I thought you just said...."?
First and foremost, let’s be clear that to be dead by brain criteria, the patient must have cessation of ALL brain function *INCLUDING absence of respiratory drive.*
Thinking "But... I thought you just said...."?
3/
The contradiction here lies in that ventilators are sometimes too sensitive.
The contradiction here lies in that ventilators are sometimes too sensitive.
1/Fun fact 4 #neurotwitter
1️⃣Lumbar puncture kit manometers measure the opening pressure in cmH2O.
2️⃣The BTF and other societies talk about concerning intracranial pressures in mmHg (threshold 20-22 mmHg, Guideline dependent).
3️⃣20 cmH2O = ~15 mmHg
4️⃣20 mmHg = ~27 cmH2O
1️⃣Lumbar puncture kit manometers measure the opening pressure in cmH2O.
2️⃣The BTF and other societies talk about concerning intracranial pressures in mmHg (threshold 20-22 mmHg, Guideline dependent).
3️⃣20 cmH2O = ~15 mmHg
4️⃣20 mmHg = ~27 cmH2O
2/
This can get equally confusing in EVDs. At @EmoryNeuroCrit we set the threshold pressures for the EVD (ie EVD @ 5, 10, 15..) in cmH2O.
But, the transducer measures and reports ICP in mmHg.
This can get equally confusing in EVDs. At @EmoryNeuroCrit we set the threshold pressures for the EVD (ie EVD @ 5, 10, 15..) in cmH2O.
But, the transducer measures and reports ICP in mmHg.
3/ Confused? Mind blown? Thought of all the pts you were worried had concerningly elevated ICP because their LP pressure was 20 cmH2O?
Join the club.
Mercury vs. Water: An Analysis of Multi-Institutional Survey Data Asse... sciencedirect.com/science/articl…
Join the club.
Mercury vs. Water: An Analysis of Multi-Institutional Survey Data Asse... sciencedirect.com/science/articl…
Was #TheDarkKnight's Two-Face the product of brain injury? Harvey Dent was hospitalized after surviving the explosion and disfiguring burns that transformed him into the psychopathic villain, Two-Face. The background offers insight into the villain's psychological origins. (1/6)
A monitor shows a computed tomography (CT) scan of Dent's head, which reveals contusions (blood) in both frontal lobes of the brain. Such contusions are common after traumatic brain injury, resulting from the brain striking the front of the skull during sudden deceleration. (2/6)
The frontal lobes support higher-order cognition, such as planning, emotional regulation, and impulse control. The ventromedial prefrontal cortex (vmPFC), the frontal region most vulnerable to contusions, is important for moral judgement and emotional decision-making. (3/6)
THE PROMISED NEUROLOGY FELLOWSHIP THREAD: I’ve taken it upon myself to hype up neurology despite being under the tutelage of medicine for the next year. Neurology gets left behind when students resolve never to live in a world where ‘dysdiadochokinesia’ is used unironically.
Disclaimer: This thread is NOT comprehensive. Neurologists practice in vast spectrums that cannot be conveyed here. This is simply meant to inform prospective applicants about the options within the field of neurology, and hopefully, to entice them to explore something(s) new.
1/ #movementdisorders (MD)- starting out this thread with a backslap to naysayers who still make the tired claim that “there’s no instant gratification in neurology.” WRONG!
🚨MUERTE CEREBRAL☠️🧠 y Doppler Transcraneal (1)
👉Deben cumplirse varios criterios
👉Acelera los tiempos de espera para protocolo de trasplante
#FOAMed #FOAMcc #MedCritUni #ICU #USG #Doppler #CriticalCare
👉Deben cumplirse varios criterios
👉Acelera los tiempos de espera para protocolo de trasplante
#FOAMed #FOAMcc #MedCritUni #ICU #USG #Doppler #CriticalCare
🚨MUERTE CEREBRAL☠️🧠 y Doppler Transcraneal (2)
👉Descartar condiciones clínicas que puedan simular MC
👉Ex neurológico compatible
#FOAMed #FOAMcc #MedCritUni #ICU #USG #Doppler #CriticalCare
👉Descartar condiciones clínicas que puedan simular MC
👉Ex neurológico compatible
#FOAMed #FOAMcc #MedCritUni #ICU #USG #Doppler #CriticalCare
🚨MUERTE CEREBRAL☠️🧠 y Doppler Transcraneal (3)
👉Test de apnea: con cuidado en retenedores crónicos de CO2
#FOAMed #FOAMcc #MedCritUni #ICU #USG #Doppler #CriticalCare
👉Test de apnea: con cuidado en retenedores crónicos de CO2
#FOAMed #FOAMcc #MedCritUni #ICU #USG #Doppler #CriticalCare
